Age is a predictor for mortality after blunt splenic injury

Area of Science:

• Trauma Surgery
• Geriatric Medicine
• Emergency Medicine

Background:

• Geriatric trauma incidence is rising, yet optimal management for high-grade blunt splenic injury (BSI) in the elderly remains debated.
• Existing data on survival rates for non-operative versus operative management in this demographic are inconsistent.

Purpose of the Study:

• To analyze mortality risk in geriatric patients with high-grade BSI, comparing operative versus non-operative management strategies.
• To investigate the independent association of age with mortality in blunt splenic injury.

Main Methods:

• Retrospective analysis of the National Trauma Database (2014-2015) for isolated, high-grade (AIS ≥ 3) BSI.
• Stratification of patients into non-elderly (<65), elderly (65-79), and advanced age (≥80) groups.
• Comparison of outcomes across non-operative, initial operative, and failed non-operative management within each age group, using multivariable logistic regression for mortality association.

Main Results:

• Mortality following failed non-operative management was significantly higher in elderly (22.2%) and advanced age (50%) groups compared to non-elderly (2%).
• Age was independently associated with mortality (AOR 1.02; p < .01).
• Elderly patients requiring surgery had over 3x increased mortality (AOR 3.39), and advanced age patients had over 8x increased mortality (AOR 8.1) compared to non-elderly.

Conclusions:

• Age is an independent predictor of mortality in patients with blunt splenic injury, irrespective of management strategy.
• Surgical intervention in elderly and advanced age patients with high-grade BSI is associated with substantially higher mortality rates.