K. Kumar1, K.R. Ghazi1, K.A. Rahim1, M.B. Musharraf1, H. Atiq1, A.H. Haider1, J.A. Razzak1 1Aga Khan University Medical College, Center Of Excellence For Trauma And Emergencies, Karachi, Sindh, Pakistan
Introduction: The older adult population is the world's fastest-expanding demographic, presenting unique issues to trauma teams. Age-related physiological changes, such as decreased reflexes and diminished functional reserve, make elderly individuals more prone to serious injuries, even from lower trauma dynamics. Common types of trauma affecting the elderly include falls and motor vehicle accidents. There is a lack of evidence for long-term mortality after older adults’ trauma in low-middle-income countries. This study aims to report long-term mortality rates and identify risk factors contributing to increased mortality among elderly trauma patients.
Methods: We conducted a prospective cohort study with a multi-center, trauma registry in Pakistan. The registry collected data on all adult (>18 years) trauma patients admitted to the ward, high dependency unit (HDU), and intensive care unit (ICU) warranting a stay of >24 hours in 2 tertiary care hospitals in Karachi from December 2021 to May 2023. These patients were followed at 1, 3, 6, and 12 months. We defined older adult patients as those aged 60 years and above. Logistic regression was used to obtain the odds ratio and 95% CI for mortality.
Results: A total of 651 patient records (mean age of 69.23 + 8.28 years, 382 (59%) males) of older adults with trauma were analyzed. The main mechanism of injury was falls (64%), followed by road traffic injuries (RTIs) (36%). Most of the patients had a moderate injury (58%) and a considerable number had a severe injury (19%). Extremity injuries were the commonest (n=368, 58%), followed by head and neck (n=239, 38%). Nearly half of patients received surgical intervention (49.31%). The in-hospital mortality rate was 17%. By the end of one year, 39% of the patients remained alive and 3.5% died making the accumulative mortality recorded was 46.2% (Table 1). RTI victim type showed 45% of RTI victims were Pedestrians. Of the patients acquiring head injuries, 71.51% experienced mortality. RTIs, severe injuries, no surgical intervention, and abnormal pulse had higher mortality. Multivariable analysis showed significantly higher odds of mortality amongst >70 years patients (AOR 2.56; 95% CI 1.44, 4.68), head injury (AOR 2.27; 95% CI 1.03, 5.0), severe ISS (AOR 2.39; 95% CI 1.04, 5.54), and no surgical intervention (AOR 1.79; 95% CI 1.05, 3.03).
Conclusion: This study reports long-term older adult trauma outcomes in Pakistan, indicating an alarmingly high mortality rate among the elderly that emphasizes the critical need for focused interventions and policies to improve the quality of life and healthcare access for older individuals.