Injury patterns and outcomes associated with elderly trauma victims in Kingston, Ontario

To characterize the common injuries incurred by elderly trauma victims and to identify the most frequent complications and outcomes.

We undertook a retrospective descriptive chart review of 125 consecutive patients who were over age 65 years and who were admitted to an academic hospital in Kingston, Ontario, over a 3-year period with an injury severity score (ISS) > 12. Complete data about the mechanism of injury (MOI), age, date, sex, specific injury, principal and secondary diagnoses, comorbid conditions, intensive care unit (ICU) and hospital length of stay and discharge disposition were recorded for 99 of these patients.

Elderly trauma cases accounted for 125 of the total 460 trauma admissions over 3 years. For that same period, more than 50% of trauma deaths occurred among elderly patients, of whom 65 were men and 34 were women. Their mean age was 77 (standard deviation [SD] 6) years, with an age range of 66-95 years. The average ISS score was 23 (SD 13), with a range of 12-75. MOI included falls (64%), motor vehicle collision (27%), injury from machinery (3%), injury from natural and environmental causes (2%), suicide or self-inflicted injury (3%) and burns (1%). The mean length of stay was 14.6 days, but this ranged from 1 to 111 days. Of the 99 patients, 14 were admitted to the ICU for a total of 37 days, and 9 of these died. Of the total of 67 (67%) patients who were discharged from hospital, 46% were discharged home and 32% died. Falls accounted for the most frequent MOI, followed by motor vehicle collisions. The most common injury in the falls group was subdural hematoma, whereas fractures were the most common injuries in the motor vehicle collision group. The most frequent complications included urinary tract infections and aspiration pneumonias. Neither age nor MOI was correlated with injury severity. Increasing age and injury severity were predictors for complications and mortality while in hospital.

Despite severe injuries, most elderly patients can survive traumatic injuries. The data suggest that, although elderly patients are prone to incur complications and have greater risk of dying as a result of their injuries, most of these patients will survive their traumatic accidents. The data also show that nosocomial complications play a significant role in the risk of mortality in elderly trauma victims.