Polytrauma in elderly

Coll. Antropol. 35 (2011) Suppl. 2: 231–234 Professional paper

Polytrauma in Elderly Nikola Gr`alja1, Igor Safti}2, Marin Marinovi}1, Damir [tigli}1 and Tedi Cicvari}1 1 2

Department of Surgery, Department of Traumatology, Rijeka University Hospital Center, Rijeka, Croatia Department of Surgery, Department of Thoracic and Vascular Surgery, Rijeka University Hospital Center, Rijeka, Croatia

ABSTRACT The aim of this study is to present certain particularities in treating polytraumatized patients age of 65 and above. All of the patients were treated in our hospital. 413 patients were included in this 4 year study (2006–2010). Injury severity score was 17 and above (ISS>17). Patients aged above 65 were sub grouped. In this 4-year period, we treated 52 or 13% elderly patients. In this subgroup there were 30 (58%) males and 22 (42%) females, with mean age of 74 (max age 95 years old). Demographic factors, injury mechanisms, patients resuscitation protocols, imaging used, etc. were also included as variables. Mortality rate in elderly patients was 31%, while in patients below 65 years of age as 12%. Taking relevant data into consideration, a special emphasis was given to certain circumstances of intensive and surgical treatment of elderly patients. A large portion of polytraumatized patients are consisted of elderly. Patients aged 65 and above have higher mortality rate with lower ISS in the mortal group and falls are the most frequent mechanism of trauma. In this study, we tried to emphasize some clinical implications when treating those patients, as well as importance in continuous medical staff education in trauma principles to minimize mortality rates. Key words: aged, elderly, Injury Severity Score, multiple trauma, mortality, trauma

Introduction In the developed countries trauma is nowadays leading cause of death in the population group between 1–44 years of age and the fifth cause of death in the group older than 65 years of age1–3. Polytraumatized patients represent 3% of total number of traumatized with high mortality rate of 16–22%4.

occur with aging can affect the ability to withstand major stress, can increase the incidence of complications and can decrease the chance for survival5. Age-related changes modify the responses to trauma and age is one of the most important determinants of mortality in trauma patients2,3.

Polytrauma in the elderly or geriatric polytrauma is defined as a polytrauma in patients of 65 years of age and over1,3. Today, people who are 65 years of age or older represent approximately 12% of the population in developed countries. It is expected that this ratio will rise to 21% in the year 20302. With the improvement in living standards they are remaining active and independent and are experiencing injury at the same rate as the rest of the population5. According to this a concomitant increase in polytrauma in the geriatric sector is predicted6.

Polytrauma is serious health problem in Croatia. Despite this epidemiological studies about trauma in Croatia are very poor8.

Compared to the younger population the treatment of geriatric trauma victims is associated with a higher mortality and morbidity7. Although the elderly are subject to the same mechanisms of injury as other age groups, geriatric patients are unique in their responses to injury. The physiologic, metabolic and biomechanical changes that

The aims of this study were to evaluate polytramatized patients over 65 years of age treated in our hospital and to emphasize some clinical implications when treating those patients, as well as importance in continuous medical staff education in trauma principles to minimize mortality rates.

Material and Methods This study is a prospective analysis done in Clinical Hospital Centre in Rijeka, in a time period between 2006th and 2010th. All of the patients here analyzed had

Received for publication June 10, 2011

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N. Gr`alja et al.: Polytrauma in Elderly, Coll. Antropol. 35 (2011) Suppl. 2: 231–234

an Injury Severity Score (ISS) above 17. Patients with age of 65 and above were abstracted as a special group. Demographic factors, injury mechanisms, ISS, pulse and systolic blood pressure, length of intensive care unit (ICU) stay, length of total hospital stay, patients resuscitation protocols, imaging used, co morbidity were included as variables. We did a comparison in variables surveyed in between the elderly patients group (65 or above) and a group of patients aged 18 to 65 years old. Patients younger than 18 were excluded.

Statistical Analysis Statistical analysis was performed using Statistica 6.1 (StatSoft, Inc, Tulsa; USA). The t-test was used for comparasuin of the means and the c 2-test for diagonal table analysis. Probability values less than 0.05 were considered significant.

Results We treated 413 polytraumatized patients in Clinical Hospital Centre Rijeka during a four year period (2006th– 2010th). Injury severity score was 17 and above (ISS>17). Out of total number of patients, 52 (13%) were 65 years of age and above, 329 (80%) were aged between 18 and 65 years, and 32 patients (7%) were minors (