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Geriatric trauma: aggressive intensive care unit management is justified
M B Shapiro1, R E Dechert, C Colwell
1Department of Surgery, University of Michigan Medical School, Ann Arbor.
The American Surgeon
|September 1, 1994
Summary
Geriatric trauma patients over 60 benefit from intensive care unit (ICU) treatment, though outcomes depend on organ system failure and head injury severity. Aggressive care improves survival but increases resource costs.
Area of Science:
- Geriatric Medicine
- Trauma Surgery
- Critical Care Medicine
Background:
- The population aged 65 and older in the United States experienced a 21% increase between 1980 and 1990.
- There is a lack of consensus regarding the characterization of geriatric trauma and predictive outcome parameters.
- Geriatric trauma management requires further investigation due to demographic shifts.
Purpose of the Study:
- To analyze the outcomes of trauma patients aged 60 and above.
- To identify factors influencing mortality and survival in this demographic.
- To evaluate the effectiveness and resource implications of intensive care unit (ICU) treatment for geriatric trauma.
Main Methods:
- Retrospective review of 170 trauma patient records (age 60+).
- Data collected over a 50-month period at a single institution.
- Analysis of patient outcomes, including mortality, length of stay, and need for post-discharge care.
Main Results:
- Overall mortality for geriatric trauma patients was 21.8%.
- No deaths occurred in the general care group (54 patients).
- Intensive care unit (ICU) survival rate was 68% (79 of 116 patients).
- ICU deaths were associated with multiple organ system failure and severe head injuries.
- Average hospital stay was 15 days, with one-third requiring skilled nursing facilities.
Conclusions:
- Aggressive ICU treatment appears justified for geriatric trauma patients, showing improved survival rates.
- Outcomes are significantly influenced by the number of failing organ systems and the presence of severe head injury.
- The high resource utilization, including extended hospital stays and need for skilled nursing facilities, necessitates careful consideration of treatment costs.