title: Penetrating torso injuries in older adults: increased mortality likely due to "failure to rescue".
abstract: OBJECTIVE
  Approximately 8 % of injuries in the elderly are from penetrating mechanisms. The natural history of potentially survivable penetrating torso wounds in the elderly is not well studied. Older adults with penetrating injuries to the torso may have worse outcomes than matched, younger patients due to a failure to rescue after complications.
  
  
  METHODS
  A retrospective chart review of all patients ≥55 (older) with a penetrating injury (GSW or SW) to the torso over 20 years was performed. All patients with a maximum AIS chest or abdomen >1 and <6 were included. A matched cohort (mechanism, AIS chest and abdomen, ISS and sex) of patients between the ages of 20-40 years (young) was created (3 young, 1 older). Differences in hemodynamics, complications, length of stay and mortality were analyzed.
  
  
  RESULTS
  105 older met inclusion criteria were compared to 315 young patients. Hemodynamic status was similar between the groups. Older patients required ICU care more often than younger patients, p < 0.05. Older patients required longer ICU stays, p < 0.001 and longer hospitalizations, p = 0.0012. More older patients (41.0 %) suffered post-injury complications compared to the young (26.4 %), p = 0.005. Older patients who suffered a complication had a higher mortality (30.2 %) than the young after a complication (10.8 %), p = 0.007.
  
  
  CONCLUSIONS
  While uncommon, penetrating injuries to older adults are associated with higher rates of post-injury complications and increased mortality. This may represent a "failure to rescue" and represent an opportunity for improved post-injury care in older adults who suffer potentially survivable penetrating torso injuries.
authors.affiliation: Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA. steve.allen@uphs.upenn.edu.
authors.forename: S R
authors.initials: SR
authors.lastname: Allen
authors.affiliation: Department of Surgery, Drexel University, Philadelphia, PA, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Scantling
authors.affiliation: Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Delgado
authors.affiliation: Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mancini
authors.affiliation: Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
authors.forename: D N
authors.initials: DN
authors.lastname: Holena
authors.affiliation: Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
authors.forename: P
authors.initials: P
authors.lastname: Kim
authors.affiliation: Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Pascual
authors.affiliation: Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
authors.forename: P
authors.initials: P
authors.lastname: Reilly
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality* / Q000628:therapy; D000368:Aged; D016022:Case-Control Studies; D003422:Critical Care / Q000706:statistics & numerical data; D000067248:Failure to Rescue, Health Care; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D013898:Thoracic Injuries / Q000150:complications / Q000401:mortality* / Q000628:therapy; D014950:Wounds, Penetrating / Q000150:complications / Q000401:mortality* / Q000628:therapy
keywords: Complications; Elderly trauma; Length of stay; Mortality; Outcome assessment; Penetrating; Traumatology; Wounds