Does age matter? The relationship between age and mortality in penetrating trauma
Introduction
According to U.S. Census Bureau projections, the age of the American population will continue to mature in the coming decades. In the year 2000, Americans over the age of 45 comprised 34.5% of the population. By the year 2020, this figure is predicted to reach 41.2%. According to 2004 projections, this shift in age demographics is anticipated to continue well into the 21st century.9
While penetrating mechanisms are less common sources of trauma among more elderly members of the population, the number of older individuals sustaining these injuries is likely to increase as the national age demographic evolves. Unfortunately, comparatively less is known about the outcomes of older patients following penetrating trauma than more common blunt mechanisms. Even as understanding of the effects of age-related physiological responses to trauma continues to evolve,4, 5 the relationship between age and outcomes of penetrating trauma remains poorly appreciated.
Section snippets
Patients and methods
After approval from the Institutional Review Board, a retrospective review of the trauma registry at the Los Angeles County+University of Southern California (LAC+USC) Medical Center was performed to identify all trauma patients admitted between January 1, 1998 and December 31, 2005. Demographic and clinical data, including age, gender, injury mechanism, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Abbreviated Injury Score (AIS) and mortality were obtained and entered into a
Results
During the 8-year period, a total of 35,184 patients were admitted. Of these, 25% sustained penetrating injuries. Individuals older than 55 years represented 3% of the total in the penetrating group and 17% in the blunt group (p < 0.0001). As outlined in Table 1, the penetrating and blunt injury groups also differed significantly for gender, GCS, ISS and AIS. Patients in the penetrating group more often were male (92% vs. 73%, p < 0.0001), had a GCS ≤ 8 (11% vs. 9%, p < 0.0001) and an ISS ≥ 16 (22% vs.
Discussion
As the population continues to mature, defining the connection between age and trauma outcomes becomes increasingly important. Several investigators have already suggested that this relationship is significant. Finelli et al.,3 in a study comparing the outcomes of trauma victims ≥65 year old to a younger cohort of similarly injured younger patients, found that older patients had markedly higher mortality (27% vs. 14%) and complication rates following major trauma. They also noted that the more
Conclusion
The mortality rate following penetrating trauma is higher than among blunt counterparts at every age interval and rises significantly after age 65. Defining the relationship between age and outcome in penetrating trauma will prove increasingly important as the population ages. An understanding of this relationship will facilitate the refinements of trauma team activation criteria and management protocols that may improve resource allocation and patient outcomes following penetrating injury.
Conflict of interest
The authors have no conflict of interest to report and have received no financial or material support related to this manuscript.
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