Outcomes of elderly trauma patients in South African level 1 trauma centres – a retrospective study

Abstract

Background: A rapidly ageing population and dramatic changes in the lifestyles of the elderly make it compelling to understand trauma in the elderly better. Overall outcomes in elderly trauma patients are essential to examine, given the costly burden attached to trauma for this population group. The aim of this study is to examine the outcomes of elderly trauma patients presenting to three level 1 South African trauma centres.

Methods: The study conducted a retrospective analysis on elderly patients between 1 January 2013 and 31 December 2016. The inclusion criteria comprised elderly individuals aged 65 years and above with an injury severity score (ISS) exceeding 10. Sixty-two elderly trauma patients met these criteria. Demographic information, mechanism of injury, length of hospital stay, in-hospital mortality outcome, and comorbidities were analysed. Descriptive statistics and chi-square tests were performed using STATA version 17. A p-value of less than 0.05 was considered statistically significant, indicating a meaningful association between variables.

Results: Sixty-two elderly trauma patients met the inclusion criteria. The study revealed highly significant negative associations between patients’ survival and key exposure variables, including the emergency department revised trauma score (RTS) (Rho = 0.481, p = 0.002), arterial pH (Rho = 0.378, p = 0.008), days spent in the high care unit (Rho = 0.586, days spent in the ward (Rho = 0.463, p = 0.004), Glasgow Coma Scale (GCS) score (Rho = -0.538, p = 0.000), brain abbreviated injury score (BAIS) (Rho = -0.525, p = 0.001), fraction of inspired oxygen level (FiO2) (Rho = -0.410, p = 0.008), blood creatinine level (Rho = -0.409, p = 0.003), and APACHE score on admission (Rho = 0.599, p = 0.001).

Conclusion: Overall, these findings suggest that factors such as severity of illness (APACHE scores), duration of ICU stay, and mode of injury play significant roles in patient outcomes across hospitals, while the impact of surgical intervention on mortality warrants further investigation due to weaker evidence. The findings underscore the direct influence of presenting physiology, injury severity, and comorbid medical conditions on outcomes for elderly trauma patients. Recognising and addressing these factors are paramount for delivering effective and tailored care to elderly trauma patients, ultimately enhancing their prospects for recovery and improved quality of life.