Futility of resuscitation criteria for the "young" old and the "old" old trauma patient: a national trauma data bank analysis.
BACKGROUND
Increasing geriatric trauma is producing disproportionate use of resources. In burn victims, age and burn extent correlate with mortality, yielding the establishment of criteria for futile resuscitation. Such criteria would be useful to trauma patients and their families in making withdrawal-of-care decisions while reducing resource use. Our objective, therefore, was to identify injury and physiologic parameters that would indicate a high probability of futile resuscitation among geriatric trauma patients.


METHODS
Data pertaining to patients greater than or equal to 65 years of age within the National Trauma Databank from 1994 to 2001 were analyzed. Multivariate logistic regression-with mortality as the outcome variable and head, chest, and/or abdominal injury; base deficit; gender; comorbidities; and admission systolic blood pressure (SBP) as covariates-was performed to develop a stratification scheme providing criteria indicative of a high probability of futile resuscitation.


RESULTS
There were 76,304 patients with a mean age of 79.4 years. Head, thoracic, and abdominal injury; age; gender; comorbidities; admission SBP; and base deficit were associated with mortality. Patients with severe chest and/or abdominal injury, moderate to severe head injury, admission SBP less than 90 mm Hg, and significant base deficit had mortalities approaching 100%. Older patients with modest shock and mild to moderate head injury admitted with severe chest and/or abdominal injury had a less than 5% chance of survival.


CONCLUSIONS
Geriatric trauma patients with severe chest and/or abdominal trauma with moderate shock and mild to moderate head injury have an exceedingly low probability of survival. These data support early withdrawal of care in these individuals.
Nirula
Ram
R
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. rnirula@mcw.edu
Gentilello
Lawrence M
LM
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D018447:Medical Futility; D017063:Outcome Assessment, Health Care; D012042:Registries; D016414:Resuscitation Orders; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*