title: Gunshot injuries in the elderly: patterns and outcomes. A national trauma databank analysis.
abstract: BACKGROUND
  Trauma in the elderly (≥ 55 years) accounts for a significant proportion of admissions to trauma centers. Our understanding of the epidemiology and outcomes associated with penetrating injury in this age segment of the population, however, is severely limited. The aim of the present study therefore was to investigate the incidence and type of injuries sustained by elderly patients from firearms and the impact of age on outcomes.
  
  
  METHODS
  This was a 5-year National Trauma Databank (NTDB) study. Injury demographics, mortality rates, and lengths of stay in the Intensive Care Unit (ICU) and the hospital were analyzed. Elderly patients ≥ 55 years old were assigned to one of three categorical strata: 55-64 years old, 65-74 years old, and ≥ 75 years old.
  
  
  RESULTS
  During the study period, 98,242 patients were admitted for firearm-related injuries, and 3,190 (3.2%) of them were ≥ 55 years old. Within the elderly age segment of the population, 1,676 patients (52.5%) were 55-64 years of age, 727 (22.8%) were 65-74 years of age, and 787 (24.7%) were ≥ 75 years old. The incidence of severe trauma [Injury Severity Score (ISS) ≥ 16] in the elderly age strata was 43.3, 46.8, and 57.6%, respectively (p < 0.001). Patients ≥ 75 years old were significantly more likely than patients 55-74 years old to suffer self-inflicted injuries. The most commonly encountered injury in elderly patients was gunshot wounds to the head, which increased in a stepwise fashion with advancing age (25.8, 31.6, and 39.4% respectively; p < 0.001). The crude mortality rate in all patients sustaining gunshot wounds increased progressively with age. Within the elderly age segment, mortality ranged from 28.5% in the age stratum 55-64 years, to 55.4% in the stratum ≥ 75 years (adjusted p < 0.001). Intensive care unit and hospital length of stay increased with advancing age but peaked and remained stable among the elderly age groups. An admission Glasgow Coma Score (GCS) ≤ 8, an ISS ≥ 16, hypotension on admission, age, self-inflicted injury, and injury sustained by assault were factors independently associated with death in patients ≥ 55 years.
  
  
  CONCLUSIONS
  Injury from firearms is not uncommon in the elderly patient population and is primarily a result of self-inflicted gunshot wounds to the head. These patients sustain a high burden of injury and a high rate of mortality, which increases with advancing age.
authors.affiliation: Division of Trauma and Critical Care, Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles County General Hospital, 1200 North State Street, IPT, C5L100, Los Angeles, CA 90033-4525, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lustenberger
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Beat
authors.initials: B
authors.lastname: Schnüriger
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Eberle
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003422:Critical Care / Q000379:methods; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery