Polytrauma in patients of 65 and over. Injury patterns and outcome

In a consecutive series of 416 patients with multiple injuries, 49 were aged 65 years or older (mean age 72.1). This group of "old" patients was compared with the remaining 367 "young" patients (mean age 31.3). In the old patients group, survivors and non-survivors were profiled. In general the injured old patient was a pedestrian hit by a car or a motorbike or someone who had simply fallen at home. Despite the fact that the mean Injury Severity Score (ISS) was significantly lower in the old patients' group (33.2 versus 42.1) (p less than 0.001), the mortality rate was significantly higher (18% versus 7.6%) (p less than 0.05). We found that in the elderly injured the ISS and preexisting diseases were not predictive of survival. However, brain injury with unconsciousness and the need for early intubation followed by long-term assisted ventilation were predictive of survival (p less than 0.001). Seventy-six per cent of the survivors were able to return home again within six months. As the final outcome in the elderly is no worse after polytrauma than after other important emergency procedures, an aggressive treatment including urgent operative fixation of major fractures is in our opinion justified.