J. O. Hwabejire1, C. Nembhard1, S. Siram1, E. Cornwell1, W. Greene1 1Howard University College Of Medicine,Surgery,Washington, DC, USA
Introduction:
Hemorrhagic shock (HS) is the leading treatable cause of trauma deaths but there are sparse data on the association between age and mortality in this condition. We examined the relationship between age and mortality as well as identified the predictors of mortality in HS.
Methods:
The Glue Grant database was analyzed. Patients aged≥16 years who sustained blunt traumatic HS were initially stratified into 8 age groups (16-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85 and above) in order to identify the mortality inflection point. For subsequent analyses, patients were stratified into: Young (16-44), Middle Age (45-64) and Elderly (65 and above). Multivariable analysis was then used to determine predictors of mortality by group.
Results:
1976 patients were included, 66% males and 89% white, with mortality of 16%. Mortality by initial age group are as follows: 16-24 (13.0%), 25-34 (11.9%), 35-44 (11.9%), 45-54 (15.6%), 55-64 (15.7%), 65-74 (20.3%), 75-84 (38.2%), 85 and above (51.6%), delineating 65 years as the mortality inflection point. Overall, 55% were Young, 30% Middle Age, and 15% Elderly. In the Young, survivors had lower emergency room (ER) lactate (4.4±2.5 vs. 8.0±4.3, p<0.001), Marshall’s multiple organ dysfunction score, MODS (4.8±2.4 vs. 6.8±4.1, p<0.001), and Injury Severity Score (ISS,32±13 vs. 39±14, p<0.001) than non-survivors. Predictors of mortality include MODS (OR:1.93,CI:1.62-2.30, p<0.001), ER lactate (OR:1.14,CI:1.02-1.27, p<0.022), ISS (OR:1.06,CI:1.03-1.09, p<0.001) and cardiac arrest (OR:10.60,CI:3.05-36.86, p<0.001. In Middle, survivors had lower MODS (5.0±2.3 vs. 7.3±4.2, p<0.001) and higher ER mean arterial pressure (74±41 mmHg vs. 63±43 mmHg, p=0.023) and were less likely than non-survivors to get a craniotomy (4% vs. 10%, p=0.025) or a thoracotomy (8% vs. 26%, p<0.001). Predictors of mortality in this group include MODS (OR:1.38,CI:1.24-1.53, p<0.001), cardiac arrest (OR:12.24,CI:5.38-27.81, p<0.001), craniotomy (OR:5.62,CI:1.93-16.37, p=0.002), and thoracotomy (OR:2.76,CI:1.28-5.98, p=0.010. In Elderly, survivors were slightly younger (74±7 vs. 78±7, p<0.001), had lower MODS (5.3±2.1 vs. 6.6±3.0, p<0.001), received higher volume of prehospital hypertonic saline (1.97±0.16 L vs. 1.83 ±0.38 L, p=0.002) and were less likely to get a laparotomy (26% vs. 63%, p<0.001). Predictors of mortality in this group include age (OR:1.07,CI:1.02-1.13, p=0.005), MODS (OR:1.47,CI:1.26-1.72, p<0.001), laparotomy (OR:2.04,CI:1.02-4.08, p=0.045) and cardiac arrest (OR:11.61,CI:4.35-30.98, p<0.001) .
Conclusion:
In blunt HS, mortality parallels increasing age, with the inflection point at 65 years. MODS and cardiac arrest uniformly predict mortality across all age groups. Open fixation of non-femur bone is uniformly protective against mortality across all age groups. Craniotomy and thoracotomy are associated with mortality in Middle Age whereas laparotomy is associated with mortality in Elderly.