Looking beyond discharge: clinical variables at trauma admission predict long term survival in the older severely injured patient.
BACKGROUND
Long term follow up is difficult to obtain in most trauma settings, these data are essential for assessing outcomes in the older (≥60) patient. We hypothesized that clinical data obtained during initial hospital stay could accurately predict long term survival.


METHODS
Using our trauma registry and hospital database, we reviewed all trauma admissions (age ≥60, ISS > 15) to our Level 1 center over the most recent 7 years. Mechanism of injury, co-morbidities, ICU admission, and ultimate disposition were assessed for 2-7 years post-discharge. Primary outcome was defined as long term survival to the end of the last year of the study.


RESULTS
Of 342 patients discharged following initial admission, mean age was 76.2 ± 9.7, and ISS was 21.5 ± 6.9. 119 patients (34.8%) died (mean follow up 18.8 months; range 1.1-66.2 months). For 233 survivors, mean follow-up was 50.2 months (range 24.8-83.8 months). Univariate analysis disclosed post-discharge mortality was associated with age (80.1 ± 9.64 vs. 74.2 ± 9.07), mean number of co-morbidities (1.6 ± 1.1 vs. 1.0 ± 1.2), fall as a mechanism, lower GCS upon arrival (11.85 ± 4.21 vs. 13.73 ± 2.89), intubation at the scene and discharge to an assisted living facility (p < 0.001 for all). Cox regression analysis hazard ratio showed that independent predictors of mortality on long term follow-up included: older age, fall as mechanism, lower GCS at admission and discharge to assisted living facility (all = p < 0.0001).


CONCLUSIONS
Nearly two-thirds of patients ≥60 who were severely injured survived >4 years following discharge; furthermore, admission data, including younger age, injury mechanism other than falls, higher GCS and home discharge predicted a favorable long term outcome. These findings suggest that common clinical data at initial admission can predict long term survival in the older trauma patient.
Department of Surgery and Shock Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. rbalam@hadassah.org.il.
Miklosh
M
Bala
Jeffry L
JL
Kashuk
Dafna
D
Willner
Dima
D
Kaluzhni
Tali
T
Bdolah-Abram
Gidon
G
Almogy