title: Clinical presentation of geriatric polytrauma patients with severe pelvic fractures: comparison with younger adult patients.
abstract: BACKGROUND
  Elderly polytrauma patients with pelvic fractures are at higher risk than young adults for severe medical outcomes and/or death in the early post-trauma phase. The aim of our study was to identify predictive factors of medical severity among geriatric polytrauma patients.
  
  
  METHODS
  We conducted a retrospective cross-sectional study of polytrauma patients treated at our center, who had a pelvic fracture and at least two other injuries with an abbreviated injury score ≥3. Our study group included 15 geriatric (mean age, 65 years) and 13 young (mean age, 39 years) adults. Factors related to medical status on admission were compared between the groups to identify those predictive of a severe medical outcome, defined by massive transfusion (>10 units of red blood cells) within the first 24 h of admission and/or death.
  
  
  RESULTS
  Groups were comparable in terms of injury severity score (mean, 29), systolic blood pressure, heart rate, shock index, hemoglobin level, the prothrombin time-to-international normalized ratio (PT-INR) and base deficit. Over two-third of geriatric patients required a massive transfusion, with two patients dying, compared with the death of one young patient. Among geriatric patients, predictors of a severe medical outcome were extravasation of contrast medium on computed tomography, a hemoglobin level <11 g/dl, a PT-INR >1.1 and a base deficit >2 mmol/l.
  
  
  CONCLUSIONS
  Even with our aggressive treatment algorism of pelvic fractures, particularly for the elderly, most of the geriatric polytrauma patients with severe pelvic fractures were at a high risk of massive transfusion. Extravasation on enhanced computed tomography and abnormal levels of select blood serum markers could assist in the early identification of geriatric polytrauma patients at risk for a severe medical outcome.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-Shi, Oita, 879-5593, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Kanezaki
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-Shi, Oita, 879-5593, Japan. masashim@oita-u.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Miyazaki
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-Shi, Oita, 879-5593, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Notani
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-Shi, Oita, 879-5593, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsumura
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001803:Blood Transfusion / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D015577:Geriatric Assessment / Q000379:methods; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D007564:Japan; D008297:Male; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Geriatric patients; Pelvic fractures; Polytrauma