Journal of Emergencies, Trauma, and Shock
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ORIGINAL ARTICLE
Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 98-103

Major trauma in elderly patients: Worse mortality and outcomes in an Italian trauma center


1 Department of Emergency, Fondazione IRCCS Policlinico San Matteo; PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
2 Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
3 Department of Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
4 Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
5 Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
6 Department of Hygiene and Health Prevention, Health Promotion-Environmental Epidemiology Unit, Health Protection Agency, Pavia, Italy
7 Department of Drug Science, University of Pavia, Saint Camillus International University of Health Sciences, Rome, Italy
8 Emergency Department, IRCCS Policlinico San Matteo, Pavia, Italy

Correspondence Address:
Gabriele Savioli
Department of Emergency, IRCCS Policlinico San Matteo, Viale C. Golgi, 19, 27100, Pavia
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_55_20

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Introduction: Major trauma is the leading cause of mortality in the world in patients younger than 40 years. However, the proportion of elderly people who suffer trauma has increased significantly. The purpose of this study is to assess the correlation of old age with mortality and other unfavorable outcomes. Methods: We assessed on one hand, anatomical criteria such as ISS values and the number of body regions affected, on the other hand, hemodynamic instability criteria, various shock indices, and Glasgow Coma Scale. Finally, we also evaluated biochemical parameters, such as lactate, BE, and pH values. We conducted a prospective and monocentric observational study of all the patients referred to the Emergency Department of the IRCCS Fondazione Policlinico S. Matteo in Pavia for major trauma in 13 consecutive months: January 1, 2018–January 30, 2019. We compared the elderly population (>75 years) and the younger population (≤75). Results: We included 501 patients, among which 10% were over the age of 75 years. The mortality rate was higher among the older patients than among the younger (4% vs. 1.33%; P = 0.050). Hemodynamic instability was more common in the older patients than in the younger (26% vs. 9%; P < 0.001). More older patients (44%) had an ISS >16, in comparison with 32% of younger patients (P = 0.01). Conclusions: The elderly showed worse outcomes in terms of mortality, hospitalization rate, hemodynamic instability criteria, and anatomical and biochemical parameters.


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