Major trauma outcomes in the elderly

To study mortality and functional outcome in elderly patients suffering major trauma and to assess whether age affects prognosis.

Retrospective identification of patients from the Royal North Shore Hospital, a level three trauma service and teaching hospital of the University of Sydney. The patients were followed up for an average of three years after admission.

One hundred and eighteen patients aged over 60 years, with injury severity scores over 15, admitted consecutively between May 1988 and July 1990. To determine the effects of age on outcome, patients were divided into two groups: those aged 61-70 years (67 patients) and over 70 years (51 patients).

Death in hospital, late death after discharge, change in preinjury v. current accommodation and current functional ability, measured with the Barthel activities of daily living index.

Thirty-six of the 118 patients died in hospital. Eighty-one of the remaining 82 patients were followed up. Twenty-five of these patients died during the study period: three in the 61-70 years age group, and 22 in the over 70 years age group (P < 0.0001). Among the long term survivors, 43 of 53 continued to live independently, and 41 of 54 scored maximum points in activities of daily living assessment. Only seven people required nursing home care.

Age is an important factor in survival after major trauma, but those that do survive generally return to full activity and independence. Aggressive treatment for elderly trauma victims is warranted.