title: Mortality in severely injured elderly patients: a retrospective analysis of a German level 1 trauma center (2002-2011).
abstract: BACKGROUND
  Demographic change is expected to result in an increase in cases of severely injured elderly patients. To determine special considerations in treatment and outcome, patients aged 75 years and older were studied.
  
  
  METHODS
  All patients in the included age group with an Injury Severity Score (ISS) ≥ 16 upon primary admission to hospital between July 2002 and December 2011 were included in this mortality analysis. The data used for this study was gained partly from data submitted to the German Trauma Register and partly from patients' hospital records. A comparison between survivors and decedents was performed, as well as age-adjusted and ISS-adjusted analyses. The odds ratio and relative risk were used to determine predictors for mortality.
  
  
  RESULTS
  One-hundred eight patients met the inclusion criteria. The overall mortality proportion was 57.4%. The decedents were more severely injured (ISS 26 vs. 20, p < 0.001) and suffered more severe head traumas (GCS 4 vs. 12, p < 0.001; AIS head 5 vs. 4, p = 0.006). No differences were found in vital parameters measured at the accident scene or trauma room. Decedents had deranged coagulation with a prolonged PTT (41.1 sec vs. 27.6 sec, p = 0.008) and reduced prothrombin ratio (66.5% vs. 82.8%, p = 0.016).
  
  
  CONCLUSIONS
  The treatment of severely injured elderly patients is challenging. The most common cause of accident is falling from less than 3 m with head injuries being determinant. We identified deranged coagulopathy as an important predictor for mortality, suggesting rapid normalization of coagulation might be a key to reducing mortality.
authors.forename: Carsten
authors.initials: C
authors.lastname: Schoeneberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Probst
authors.forename: Marc
authors.initials: M
authors.lastname: Schilling
authors.forename: Alexander
authors.initials: A
authors.lastname: Wegner
authors.forename: Bjoern
authors.initials: B
authors.lastname: Hussmann
authors.forename: Sven
authors.initials: S
authors.lastname: Lendemans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality*