title: Vascular trauma in geriatric patients: a national trauma databank review.
abstract: BACKGROUND
  The epidemiology of vascular injuries in the geriatric patient population has not been described. The purpose of this study was to examine nationwide data on vascular injuries in the geriatric patients and to compare this with the nongeriatric adult patients with respect to the incidence, injury mechanisms, and outcomes.
  
  
  METHODS
  Geriatric patients aged 65 or older with at least one traumatic vascular injury were compared with an adult cohort aged 16 years to 64 years with a vascular injury using the National Trauma Databank version 7.0.
  
  
  RESULTS
  During the study period, 29,736 (1.6%) patients with a vascular injury were identified. Of those, geriatric patients accounted for 7.6% (2,268) and the nongeriatric adult patients accounted for 83.1% (n=24,703). Compared with the nongeriatric adult patients, the geriatric vascular patients had a significantly higher Injury Severity Score (26.6±17.0 vs. 21.3±16.7; p<0.001) and less frequently sustained penetrating injuries (16.1% vs. 54.1%; p<0.001). The most commonly injured vessels in the elderly were vessels of the chest (n=637, 40.2%), including the thoracic aorta and innominate and subclavian vessels. The overall incidence of thoracic aorta injuries was significantly higher in geriatric patients (33.0% vs. 13.9%; p<0.001) and increased linearly with progressing age. After adjusting for confounding factors, geriatric patients demonstrated a fourfold increase in mortality following vascular injuries (adjusted odds ratio, 3.9; 95% confidence interval, 3.32-4.58; p<0.001).
  
  
  CONCLUSIONS
  Vascular trauma is rare in the geriatric patient population. These injuries are predominantly blunt, with the thoracic aorta being the most commonly injured vessel. Although vascular injuries occur less frequently than in the nongeriatric cohort, in the geriatric patient, vascular injury is associated with a fourfold increase in adjusted mortality.
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles County Medical Center, Los Angeles, California 90033, USA.
authors.forename: Agathoklis
authors.initials: A
authors.lastname: Konstantinidis
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Joe
authors.initials: J
authors.lastname: Dubose
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: David
authors.initials: D
authors.lastname: Plurad
authors.forename: Bernardino C
authors.initials: BC
authors.lastname: Branco
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000293:injuries; D001808:Blood Vessels / Q000293:injuries*; D016122:Brachiocephalic Trunk / Q000293:injuries; D016121:Brachiocephalic Veins / Q000293:injuries; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000293:injuries; D013350:Subclavian Vein / Q000293:injuries; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality; D055815:Young Adult