Age-related injury patterns in Spanish trauma ICU patients. Results from the RETRAUCI.
BACKGROUND
Injury patterns may differ in trauma patients when age is considered. This information is relevant in the management of trauma patients and for planning preventive measures.


METHODS
We included in the study all patients admitted for traumatic disease in the participating ICUs from November 23rd, 2012 to July 31st, 2015 with complete records. Data on epidemiology, injury patterns, severity scores, acute management, resources utilisation and outcome were recorded and compared in the following groups of age: ≤55years (young adults), 56-65 years (adults), 66-75 years (elderly), >75years (very elderly). Quantitative data were reported as median (Interquartile Range (IQR) 25-75) and categorical data as number and percentage. Comparison between groups of age with quantitative variables was performed using the analysis of variance (ANOVA) test. Differences between groups with categorical variables were compared using the chi-square test. A value of p<0.05 was considered significant.


RESULTS
We included 2700 patients (78.9% male). Median age was 46 (31-62) years. Blunt trauma was present in 93.7% of the patients. Median RTS was 7.55 (5.97-7.84). Median ISS was 20 (13-26). High-energy trauma secondary to motor-vehicle accident with rhabdomyolysis and drugs abuse showed an inverse linear association with ageing, whilst pedestrian falls with isolated brain injury, being run-over and pre-injury antiplatelets or anticoagulant treatment increased with age (in all cases p<0.001). Multiple injuries were more common in young adults (p<0.001). Acute kidney injury prevalence was higher in elderly and very elderly patients (p<0.001). ICU Mortality increased with age in spite of similar severity scores in all groups (p<0.001). The main cause of death in all groups was intracranial hypertension.


CONCLUSIONS
Different injury patterns exist in relation with ageing in trauma ICU patients. Adult patients were more likely to present high-energy trauma with significant injuries in different areas whilst elderly patients were prone to low-energy falls, complicated by antiplatelets or anticoagulants use, resulting in severe brain injury and increased mortality.
Servei de Medicina Intensiva. Hospital Universitari Son Espases, Palma de Mallorca, Spain.
Juan Antonio
JA
Llompart-Pou
UCI de Trauma y Emergencias. Servicio de Medicina Intensiva. Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: murgchico@yahoo.es.
Mario
M
Chico-Fernández
Servicio de Medicina Intensiva. Hospital Virgen de la Salud, Toledo, Spain.
Marcelino
M
Sánchez-Casado
Servicio de Medicina Intensiva. Hospital Universitario de Donostia, San Sebastián, Spain.
Fermín
F
Alberdi-Odriozola
Servicio de Medicina Intensiva. Hospital Universitario Virgen de las Nieves, Granada, Spain.
Francisco
F
Guerrero-López
Servicio de Medicina Intensiva. Complejo Hospitalario de Torrecárdenas, Almería, Spain.
María Dolores
MD
Mayor-García
Servicio de Medicina Intensiva. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
Javier
J
González-Robledo
Servicio de Medicina Intensiva. Hospital Universitario Marqués de Valdecilla, Santander, Spain.
María Ángeles
MÁ
Ballesteros-Sanz
Servicio de Medicina Intensiva. Hospital Universitario Río Hortega, Valladolid, Spain.
Rubén
R
Herrán-Monge
Servicio de Medicina Intensiva. Ciudad Sanitaria Reina Sofía, Córdoba, Spain.
Rafael
R
León-López
Servicio de Medicina Intensiva. Hospital Universitario Central De Asturias, Asturias, Spain.
Lucía
L
López-Amor
Servicio de Medicina Intensiva. Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
Ana
A
Bueno-González
D058186:Acute Kidney Injury / Q000401:mortality*; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000375:Aging; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D019586:Intracranial Hypertension / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D014193:Trauma Centers
D000925:Anticoagulants
Elderly; Injury patterns; Intensive care unit; Trauma; Trauma registry