Trauma in the Elderly: Demographic Trends (1995-2014) in a Major New Zealand Trauma Centre.World J Surg. 2019 Feb; 43(2):466-475.WJ
Population studies have confirmed an increase in the proportion of elderly patients (≥65 years of age), and this could be expected to be reflected in trauma admissions and outcomes. This study aims to investigate the demographic trends for elderly patients admitted following trauma to Auckland City Hospital (ACH) and their outcomes.
MATERIALS AND METHODS
The ACH Trauma Database was searched from 1995 to 2014, and data including date of admission, injury cause, age, sex, mortality, Injury Severity Score (ISS), Intensive Care Unit (ICU) stay and length of stay (LOS) were extracted.
A total of 26,882 patients were identified, with 4428 patients ≥65 years of age admitted following trauma. In the mid-1990s between 200 and 250 trauma patients ≥65 years were admitted to ACH annually. This has increased to >400 in 2014 and now represents >20% of all admissions. Females are over represented (61.7%) in those ≥65 years (vs. 29.4% in < 65 years, p < 0.001), and falls are the greatest cause of admission for trauma in those ≥65 years at 72% (vs. 36.9% in those < 65 years, p < 0.001). Elderly trauma patients are more than twice as likely to die (5.6% vs. 2.3%, p < 0.001) compared with trauma patients < 65 years despite an identical median ISS of 4 (p = 0.86). Furthermore, of those ≥65 years, 2.2% died of minor/moderate trauma (ISS ≤ 15) versus only 0.12% for those < 65 years confirming the complexities of ageing physiology in a trauma setting. Until 2003, mortality from trauma in elderly patients closely paralleled the rate of severe trauma admissions (ISS ≥ 16), but after 2003, despite a steady increase in severe trauma in this cohort, mortality rates have fallen.
Elderly patients bring with them a greater burden of co-morbidities, and trauma admission of elderly patients has almost doubled over 20 years, including severe trauma (ISS ≥ 16), but despite this mortality has decreased. Integration of services into the new ACH in 2003 as well as improving trauma and medical care may be possible explanations. Further resources will be required to meet service demand, along with consideration of strategies to integrate multi-disciplinary care and consolidate trauma management for this vulnerable patient group.