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Reality of treatment for severely injured patients: are there age-specific differences?
Teresa Maek1, Ulrike Fochtmann1, Pascal Jungbluth2
1Department of Orthopedics and Trauma Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
Insights
Elderly patients and children with severe injuries receive less invasive treatment than adults. Outcomes differ, with children having the lowest mortality and elderly patients faring the worst.
Area of Science:
- Trauma care research
- Geriatric medicine
- Pediatric emergency medicine
Background:
- Major trauma is a leading global cause of death across all age groups.
- Age-specific responses to trauma are not well-studied, despite known physiological differences between children and the elderly.
- Comparative investigations into trauma treatment and outcomes across different age demographics are limited.
Purpose of the Study:
- To analyze and compare treatment and outcomes in severely injured patients across different age groups.
- To utilize a matched triplet analysis to control for injury severity and hospital level.
- To investigate age-specific differences in trauma management and patient outcomes.
Main Methods:
- Analysis of data from the TraumaRegister DGU® (2011-2020).
- Inclusion of 56,115 patients with Maximum Abbreviated Injury Scale (MAIS) scores between 3 and 5.
- Matched triplet analysis comparing children (3-15 years), adults (20-50 years), and the elderly (70-90 years) based on exact injury severity and hospital level.
Main Results:
- 2,590 matched triplets were identified.
- Traffic accidents were the primary cause of severe injury in children and adults; low falls predominated in the elderly.
- Elderly patients received less resuscitation and fewer interventions, experienced worse outcomes, and had higher mortality; children had the lowest mortality rates.
Conclusions:
- Severely injured elderly patients and children may receive less invasive treatment compared to adults with identical injury severity.
- Outcomes are divergent between pediatric and geriatric trauma patients, with children showing better survival rates.
- Future trauma guidelines and research must explicitly consider age-specific treatment and outcome variations.
Background:
Major trauma and its consequences are one of the leading causes of death worldwide across all age groups. Few studies have conducted comparative age-specific investigations. It is well known that children respond differently to major trauma than elderly patients due to physiological differences. The aim of this study was to analyze the actual reality of treatment and outcomes by using a matched triplet analysis of severely injured patients of different age groups.
Methods:
Data from the TraumaRegister DGU® were analyzed. A total of 56,115 patients met the following inclusion criteria: individuals with Maximum Abbreviated Injury Scale > 2 and < 6, primary admission, from German-speaking countries, and treated from 2011-2020. Furthermore, three age groups were defined (child: 3-15 years; adult: 20-50 years; and elderly: 70-90 years). The matched triplets were defined based on the following criteria: 1. exact injury severity of the body regions according to the Abbreviated Injury Scale (head, thorax, abdomen, extremities [including pelvis], and spine) and 2. level of the receiving hospital.
Results:
A total of 2,590 matched triplets could be defined. Traffic accidents were the main cause of severe injury in younger patients (child: 59.2%; adult: 57.9%). In contrast, low falls (from < 3 m) were the most frequent cause of accidents in the elderly group (47.2%). Elderly patients were least likely to be resuscitated at the scene. Both children and elderly patients received fewer therapeutic interventions on average than adults. More elderly patients died during the clinical course, and their outcome was worse overall, whereas the children had the lowest mortality rate.
Conclusions:
For the first time, a large patient population was used to demonstrate that both elderly patients and children may have received less invasive treatment compared with adults who were injured with exactly the same severity (with the outcomes of these two groups being opposite to each other). Future studies and recommendations should urgently consider the different age groups.
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