Age as a Predictor of Mortality, Disability, or Need for Acute Resuscitative Care in Trauma Patients

Geriatric trauma patients are at increased risk of death or disability, and some have proposed trauma team activations based on advanced age alone. We sought to determine if there is a specific age at which a different approach to the trauma patient should be taken, based on their age-related risk for death, disability, or for needing acute resuscitative care.

We conducted a retrospective review of one year of data (2022) abstracted from the National Trauma Data Bank, including 984,335 adult trauma patients. The primary outcome was in-hospital mortality. Secondary outcomes were non-functional status at discharge, and a composite outcome created to capture the need for acute trauma interventions that included death in the ED, admission to the ICU, or need for emergent surgery, intubation, angioembolization, blood transfusions or procedures.

Analyses adjusted for covariates showed the risk of receiving any acute intervention, including transfusions, surgeries, intubations and bedside procedures, all fell steadily with advancing age, as did risk of immediate death in the emergency department. Risk of death later during hospitalization, or of discharge to a non-functional status, rose steadily with advancing age.

Trauma patients have rising mortality with advancing age, and a rise in likelihood of being sent to the ICU for care, but a falling rate of immediate, up-front death in the trauma bay, and a falling rate of receiving the acute, life-saving interventions associated with a trauma team activation. Further investigation is needed to determine the extent to which these findings illustrate differences in injury mechanism and severity, or age-related bias and differences in care.