title: Octogenarians and motor vehicle collisions: postdischarge mortality is lower than expected.
abstract: BACKGROUND
  Motor vehicle collisions (MVCs) are the second leading cause of injury among octogenarians. Physicians and families lack outcomes-based data to assist in the decision-making process concerning injury treatment in this population. The purpose of this study was to evaluate 1-year postdischarge mortality in octogenarian MVC patients, cause of death, and patterns predictive of mortality.
  
  
  METHODS
  A 10-year retrospective review was conducted of trauma patients 80 years and older who were involved in an MVC and were subsequently discharged alive. Data collected included demographics, injury severity and patterns, hospitalization details, and outcomes. State death database and hospital records were queried to determine cause of death for patients who died within 12 months of hospital discharge. Analyses were conducted to explore if a relationship existed between severity of injury and injury patterns to 12-month postdischarge mortality.
  
  
  RESULTS
  Among the 199 patients included in this study, mean (SD) age and Injury Severity Score (ISS) was 84.2 (3.3) years and 9.3 (8.2), respectively. Twenty-two patients (11.1%) died within 12 months. Among these patients, cause of death was directly related to trauma in nine (40.9%), likely related to trauma in seven (31.8%), and unrelated to trauma in six (27.3%). More severely injured patients (ISS >15, p = 0.0041) and those admitted to the intensive care unit (ICU) (p = 0.0051) were more likely to die within 12 months of discharge. Results indicated a trend toward higher mortality in patients with pneumonia. Rib, hip, and pelvic fractures; spinal injuries; intubation upon hospital arrival; and need for mechanical ventilation were not associated with higher postdischarge mortality rates.
  
  
  CONCLUSIONS
  The commonly held belief that the majority of octogenarians with MVC-related trauma die within 1 year of hospital discharge is refuted by this study. Only injury severity, ICU admission, and ICU duration were predictive of mortality within 12 months following discharge.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: From the Departments of Surgery (K.S., S.D.H., M.L.L., R.J.N., J.M.H.) and Preventive Medicine and Public Health (F.D.); The University of Kansas School of Medicine-Wichita; the Kansas Department of Health and Environment (G.C.); and the Department of Trauma Services, Via Christi Hospital Saint Francis (J.G.W., R.J.N., J.M.H.), Wichita, Kansas.
authors.forename: Kathryn S
authors.initials: KS
authors.lastname: Soba
authors.forename: Frank
authors.initials: F
authors.lastname: Dong
authors.forename: Jeanette G
authors.initials: JG
authors.lastname: Ward
authors.forename: Greg
authors.initials: G
authors.lastname: Crawford
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Helmer
authors.forename: Michael L
authors.initials: ML
authors.lastname: Lemon
authors.forename: R Joseph
authors.initials: RJ
authors.lastname: Nold
authors.forename: James M
authors.initials: JM
authors.lastname: Haan
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007615:Kansas / Q000453:epidemiology; D008297:Male; D010351:Patient Discharge; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality*