Older age and post-traumatic organ failure a TraumaRegister DGU^® analysis of 34,469 elderly major trauma patients

As the number of elderly major trauma patients (EMTP) increases continuously, this study sought to determine the incidence of organ failure (OF) and multiple organ failure (MOF) and their impact on mortality and recovery status in this cohort.

Based on the German TraumaRegister DGU^® database this study included EMTP aged between 65 and 99 years with an Injury Severity Score (ISS) of ≥ 16 between 2014 and 2023. OF was defined as Sequential Organ Failure Assessment (SOFA) score of ≥ 3 and MOF as failure of ≥ 2 organs.

The database revealed 34,469 EMTP, here 37% suffered from OF (16.0%) or MOF (21.0%). Mortality was significantly higher in OF and MOF patients compared to non-OF patients (non-OF: 7.4%; OF: 45.0%; MOF: 59.0%; p < 0.001). 80.9% of all deaths were associated with failure of at least one organ and 51.1% of non-survivors suffered from MOF. Highest odds ratios (OR) for mortality were found for liver (OR: 5.13, p < 0.001), central nervous system (OR: 3.63, p < 0.001) and renal failure (OR: 3.25, p < 0.001), followed by cardiovascular (OR: 1.95, p < 0.001) and lung failure (OR: 1.16, p = 0.010). Haemostatic failure had no impact on mortality.

OR and mortality differ significantly between distinct OFs due to varying degrees of success in treatment options and systemic impact of these OFs. Clinicians should be aware that OF and MOF occur frequently in EMTP and that these patients have a high risk of dying. Therefore, close screening for and prompt treatment of OF and MOF could be a key strategy to lower mortality of EMTP.