V. Gahlawat1, J. A. Vosswinkel1, A. J. Singer1, M. J. Shapiro1, J. E. McCormack1, E. Huang1, R. S. Jawa1 1Stony Brook University Medical Center,Stony Brook, NY, USA
Introduction: A variety of factors are thought to influence outcomes following geriatric trauma. However, there is little detailed information regarding the effects of complications on outcomes following admissions for blunt trauma in the elderly.
Methods: We performed a retrospective review of the trauma registry at a suburban regional trauma center from 2010 to 2015 for all elderly (>65 y) blunt trauma admissions with hospital length of stay (LOS) ≥ 3 days. Deaths in Emergency Department, burns and cardiac arrest were excluded. Patients were divided into three groups- No Complications [NC], minor complications only [MC], and major complications with or without minor complications [SC]. Major and Minor complications were defined as per TQIP. Univariate and multivariate analyses were performed.
Results: There were 2,469 admissions meeting inclusion criteria, NC (n=1,984), MC (n=211) and SC (n=274). There was no significant difference amongst groups in terms of age (median years; NC- 81, MC- 82, SC- 81, p=0.60) and frequency of low fall as the mechanism of injury (NC- 74.7%, MC- 73.5%, SC- 72.3%, p=0.64). Pre-admission Do Not Resuscitate directive (DNR, NC- 6.6%, MC- 10.4%, SC- 9.9%, p=0.025) and Injury severity score (ISS, median [IQR]; NC- 9[5.5-13] , MC- 10[9-16], SC- 12[9-17], p<0.001) were lower in no complications group. With regards to outcomes, patients who suffered major complications after blunt trauma had increased intensive care unit (ICU) LOS, mechanical ventilation, hospital LOS, in-hospital mortality and fewer discharge to home (Table 1). In-hospital mortality increased with increasing number of major complications (0-2.6%, 1-12%, 2-29%, 3-20.0%, 4-50%). On multivariate stepwise forward logistic regression analysis, factors significantly associated with in-hospital mortality (Odds Ratios with 95%CI) were mechanical ventilation (9.56 [5.08-18.00]), pre-admission DNR (5.01 [2.64-9.49]), ICU stay (2.12 [1.06-4.23]), low fall mechanism of injury (2.07 [1.12-3.83]), major complications (1.56 [1.17-2.06]), ISS (1.08 [1.05-1.12]), and age (1.04 [1.01-1.07]).
Conclusion: Low fall was the most frequent mechanism of injury. There was a near linear relationship between the number of major complications and in-hospital mortality in elderly patients admitted with blunt trauma. The multivariate model had excellent discriminative characteristics for mortality, with an AUCROC of 0.911. The probability of death during hospitalization increased by a factor of 1.56 with each major complication (i.e. OR 6.24 with 4 complications). Once even a single major complication has occurred, great vigilance is warranted to prevent in-hospital mortality. Further study in a larger cohort is warranted.
