Are There Any Red Flag Injuries in Severely Injured Patients in Older Age?

Daniel Popp; Borys Frankewycz; Siegmund Lang; Antonio Ernstberger; Volker Alt; Michael Worlicek; Maximilian Kerschbaum

doi:10.3390/jcm10020185

Are There Any Red Flag Injuries in Severely Injured Patients in Older Age?

J Clin Med. 2021 Jan 7;10(2):185. doi: 10.3390/jcm10020185.

Authors

Daniel Popp^{1

2}, Borys Frankewycz¹, Siegmund Lang¹, Antonio Ernstberger³, Volker Alt¹, Michael Worlicek¹, Maximilian Kerschbaum¹

Affiliations

¹ Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany.
² Clinic for Trauma and Orthopedic Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
³ Department of Trauma and Hand Surgery, Hospital Osnabrück, 49076 Osnabrück, Germany.

Abstract

Introduction: Severely injured elderly patients pose a significant burden to trauma centers and, compared with younger patients, have worse prognoses and higher mortality rates after major trauma. The objective of this study was to identify the etiological mechanisms that are associated with severe trauma in elderly patients and to detect which injuries correlate with high mortality in elderly patients.

Methods: Using a prospect cohort study model over an 11-year period, severely injured patients (ISS ≥ 16) were divided into two age groups (Group 1: 18-64; Group 2: 65-99 years). A comparison of the groups was conducted regarding injury frequency, trauma mechanism, distribution of affected body parts (AIS and ISS regions) and injury related mortality.

Results: In total, 1008 patient were included (Group 1: n = 771; Group 2: n = 237). The most relevant injury in elderly patients was falling from low heights (<3 m) in contrast to traffic accident in young patients. Severely injured patients in the older age group showed a significantly higher overall mortality rate compared to the younger group (37.6% vs. 11.7%; p = 0.000). In both groups, the 30-day survival for patients without head injuries was significantly better compared to patients with head injuries (92.7% vs. 85.3%; p = 0.017), especially analyzing elderly patients (86.6% vs. 58.6%; p = 0.003). The relative risk of 30-day mortality in patients who suffered a head injury was also higher in the elderly group (OR: Group 1: 4.905; Group 2: 7.132).

Conclusion: In contrast to younger patients, falls from low heights (<3 m) are significant risk factors for severe injuries in the geriatric collective. Additionally, elderly patients with an ISS ≥ 16 had a significantly higher mortality rate compared to severe injured younger patients. Head injuries, even minor head traumata, are associated with a significant increase in mortality. These findings will contribute to the development of more age-related therapy strategies in severely injured patients.

Keywords: elderly patients; head injury; mortality; severe injury.