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April 1994

Mortality Factors in Geriatric Blunt Trauma Patients

Author Affiliations

From the Department of Surgery, University of California, San Francisco (Drs Knudson and Lieberman); the Department of Surgery, San Francisco (Calif) General Hospital (Dr Knudson); the Department of Surgery, Vanderbilt University Medical Center, Nashville, Tenn (Dr Morris); the National Study Center for Trauma and Emergency Medical Systems and the Maryland Institute for Emergency Medical Services Systems, Department of Surgery, University of Maryland, Baltimore (Dr Cushing); and the Center for Injury Prevention and Research, San Francisco, Calif (Dr Stubbs).

Arch Surg. 1994;129(4):448-453. doi:10.1001/archsurg.1994.01420280126017

Objective:  To examine various clinical factors for their ability to predict mortality in geriatric patients following blunt trauma.

Design:  In this retrospective study, trauma registries and medical records from three trauma centers were reviewed for patients 65 years and older who had sustained blunt trauma. The following variables were extracted and examined independently and in combination for their ability to predict death: age, gender, mechanism of injury, admission blood pressure, and Glasgow Coma Scale score, respiratory status, Trauma Score, Revised Trauma Score, and Injury Severity Score.

Setting:  Three urban trauma centers.

Patients:  Geriatric trauma patients entering three trauma centers (Stanford [Calif] University Hospital, Vanderbilt University Medical Center, Nashville, Tenn, and Maryland Institute for Emergency Medical Services Systems, Baltimore) following blunt trauma during a 7-year period (1982 to 1989).

Results:  The Injury Severity Score was the single variable that correlated most significantly with mortality. Mortality rates were higher for men than for women and were significantly higher in patients 75 years and older. Admission variables associated with the highest relative risks of death included a Trauma Score less than 7; hypotension (systolic blood pressure, <90 mm Hg); hypoventilation (respiratory rate, <10 breaths per minute); or a Glasgow Coma Scale score equal to 3.

Conclusions:  Admission variables in geriatric trauma patients can be used to predict outcome and may also be useful in making decisions about triage, quality assurance, and use of intensive care unit beds.(Arch Surg. 1994;129:448-453)

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