Mortality factors in geriatric blunt trauma patients
M. M. Knudson, J. Lieberman, J. A. Morris Jr, B. M. Cushing and H. A. Stubbs
Department of Surgery, University of California, San Francisco.
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.
