title: Injury Characteristics and Outcomes in Elderly Trauma Patients in Sub-Saharan Africa.
abstract: Traumatic injury in the elderly is an emerging global problem with an associated increase in morbidity and mortality. This study sought to describe the epidemiology of elderly injury and outcomes in sub-Saharan Africa.
  
  
  
  We conducted a retrospective analysis of adult patients (≥ 18 years) with traumatic injuries presenting to the Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, over 5 years (2009-2013). Elderly patients were defined as adults aged ≥65 years and compared to adults aged 18-44 and 45-64 years. We used propensity score matching and logistic regression to compare the odds of mortality between age groups using the youngest age group as the reference.
  
  
  
  42,816 Adult patients with traumatic injuries presented to KCH during the study period. 1253 patients (2.9 %) were aged ≥65 years with a male preponderance (77.4 %). Injuries occurred more often at home as age increased (25.3, 29.5, 41.1 %, p < 0.001) and falls were more common (14.1, 23.8, 36.3 %, p < 0.001) for elderly patients. Elderly age was associated with a higher proportion of hospital admissions (10.6, 21.3, 35.2 %, p < 0.001). Upon propensity score matching and logistic regression analysis, the odds ratio of mortality for patients aged ≥65 was 3.15 (95 % CI 1.45, 6.82, p = 0.0037) compared to the youngest age group (18-44 years).
  
  
  
  Elderly trauma in a resource-poor area in sub-Saharan Africa is associated with a significant increase in hospital admissions and mortality. Significant improvements in trauma systems, pre-hospital care, and hospital capacity for older, critically ill patients are imperative.
authors.affiliation: Department of Surgery, University of North Carolina School of Medicine, CB# 7228, Chapel Hill, NC, USA.
authors.forename: Jared R
authors.initials: JR
authors.lastname: Gallaher
authors.affiliation: Department of Surgery, University of Maryland, Baltimore, MD, USA.
authors.forename: Bryce E
authors.initials: BE
authors.lastname: Haac
authors.affiliation: Air Force Institute of Technology (AFIT/ENC), Wright-Patterson Afb, OH, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Geyer
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Charles
authors.initials: C
authors.lastname: Mabedi
authors.affiliation: North Carolina Jaycee Burn Center, Department of Surgery, School of Medicine, University of North Carolina, CB# 7600, Chapel Hill, NC, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.affiliation: Department of Surgery, University of North Carolina School of Medicine, CB# 7228, Chapel Hill, NC, USA. anthchar@med.unc.edu.|Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. anthchar@med.unc.edu.|North Carolina Jaycee Burn Center, Department of Surgery, School of Medicine, University of North Carolina, CB# 7600, Chapel Hill, NC, USA. anthchar@med.unc.edu.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Charles
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult