A Case Control Study for Major Trauma in Geriatric Patients
| Autor: | Johann Jonsson, Susan A. Morelli, William J. Fouty, Howard R. Champion, Frederick C. Finelli |
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| Rok vydání: | 1989 |
| Předmět: |
Adult
Pediatrics medicine.medical_specialty Time Factors Adolescent Injury control Accident prevention Poison control Critical Care and Intensive Care Medicine Severity of Illness Index Suicide prevention Occupational safety and health Cohort Studies Injury prevention medicine Humans Aged Aged 80 and over business.industry Data Collection Major trauma Case-control study Middle Aged medicine.disease Surgery Hospitalization District of Columbia Costs and Cost Analysis Wounds and Injuries business |
| Zdroj: | The Journal of Trauma: Injury, Infection, and Critical Care. 29:541-548 |
| ISSN: | 0022-5282 |
| DOI: | 10.1097/00005373-198905000-00001 |
| Popis: | This study analyzed age as a univariate factor in survival in a national group of 46,613 major trauma patients and compared 180 elderly major trauma patients (greater than or equal to 65 years) to a similarly injured group of 3,918 younger patients (less than 65 years). In the national group, mortality rose sharply between age 45 (10%) and 55 (15%) and doubled at age 75 years (20%). This age-dependent survival decrement occurred at all Injury Severity Score values, for all mechanisms of injury, and for all body regions. In the comparison study, mortality in the elderly group was nearly double that of mortality in the younger group (27% vs. 14%). The older patients had a markedly higher complication death rate, especially for pulmonary (14/100 vs. 6.1/1100) and infectious complications (4.6/100 vs. 0.7/100). The median length of stay was twice as long for the older patients (14 days vs. 7 days). Cost data showed that the DRG prospective payment system grossly underestimated the cost of care for these patients (mean loss of $2,177.14 per patient). To minimize mortality and morbidity, triaging elderly trauma victims to trauma centers at a much lower threshold than similarly injured younger patients is recommended. The current DRG system should be altered to account for age-dependent morbidity. Further study is needed to determine whether more rigorous infection prophylaxis, immunomodulation, and pulmonary therapy will augment survival in elderly patients. |
| Databáze: | OpenAIRE |
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