Impact of advanced age on outcomes following damage control interventions for trauma.
BACKGROUND
Damage control (DC) strategy has significantly contributed to mortality reduction in massively bleeding and critically injured trauma victims. However, there is a lack of literature validating the effectiveness of this approach in the elderly population.


METHODS
The trauma registry of a Level I trauma center was utilized to identify all severely injured patients [Injury Severity Score (ISS) ≥16] from January 1996 to December 2007 who underwent initial DC procedures. Patients with a head Abbreviated Injury Scale (AIS) ≥3 were excluded from the analysis. Demographics, clinical and physiological parameters, and in-hospital outcome measures were compared between elderly (≥55 years) and younger (<55 years) patient cohorts subjected to DC procedures.


RESULTS
Overall, 158 patients met the inclusion criteria. Among them, 34 patients (21.5%) were aged ≥55 years (range 55-85 years) and 124 patients (78.5%) were <55 years old (range 16-54 years). The overall in-hospital mortality rate was 10.1% (n = 16) with a significantly higher mortality rate for elderly patients than for younger patients: 29.4% vs. 4.8%; adjusted P = 0.001; adjusted odds ratio (OR) with 95% confidence interval (CI) 7.09 (2.30-21.74). When stratified by DC subgroups, the case-fatality rate was significantly higher for the elderly patients who underwent extremity DC procedures [19.2% vs. 3.2%; adjusted P = 0.032; adjusted OR with 95% CI 5.95 (1.16-30.30)] and DC laparotomy [55.6% vs. 7.1%; P = 0.005; OR and 95% CI 16.25 (2.32-114.06)]. Both cohorts required massive transfusion during the initial 24 h of admission (18.9 ± 2.9 vs. 15.1 ± 1.6 units of packed red blood cells; P = 0.290). Nevertheless, there were no statistically significant differences between the two groups regarding hospital and surgical intensive care unit lengths of stay or major in-hospital complications.


CONCLUSIONS
The mortality rate for elderly trauma patients undergoing DC is excessive at 29%. Despite the significant burden of injury and the massive transfusion requirement, most of the elderly patients subjected to DC survived and experienced in-hospital morbidity measures comparable to those of the younger patients. Our results provide further support for damage control intervention in severely injured elderly patients.
Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. tom.lustenberg@gmail.com
Thomas
T
Lustenberger
Peep
P
Talving
Beat
B
Schnüriger
Barbara M
BM
Eberle
Marius J B
MJ
Keel
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D055815:Young Adult