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European Journal of Trauma and Emergency Surgery

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Open Access 01-02-2022 | Central Nervous System Trauma | Original Article

Geriatric polytrauma patients should not be excluded from aggressive injury treatment based on age alone

Authors: Karlijn J. P. van Wessem, Luke P. H. Leenen

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2022

Abstract

Purpose

Age in severely injured patients has been increasing for decades. Older age is associated with increasing mortality. However, morbidity and mortality could possibly be reduced when accurate and aggressive treatment is provided. This study investigated age-related morbidity and mortality in polytrauma including age-related decisions in initial injury management and withdrawal of life-sustaining therapy (WLST).

Methods

A 6.5-year prospective cohort study included consecutive severely injured trauma patients admitted to a Level-1 Trauma Center ICU. Demographics, data on physiology, resuscitation, MODS/ARDS, and infectious complications were prospectively collected. Patients were divided into age subgroups (< 25, 25–49, 50–69, and ≥ 70 years) to make clinically relevant comparisons.

Results

391 patients (70% males) were included with median ISS of 29 (22–36), 95% sustained blunt injuries. There was no difference in injury severity, resuscitation, urgent surgeries, nor in ventilator days, ICU-LOS, and H-LOS between age groups. Adjusted odds of MODS, ARDS and infectious complications were similar between age groups. 47% of patients ≥ 70 years died, compared to 10–16% in other age groups (P < 0.001). WLST increased with older age, contributing to more than half of deaths ≥ 70 years. TBI was the most common cause of death and decision for treatment withdrawal in all age groups.

Conclusions

Patients ≥ 70 years had higher mortality risk even though injury severity and complication rates were similar to other age groups. WLST increased with age with the vast majority due to brain injury. More than half of patients ≥ 70 years survived suggesting geriatric polytrauma patients should not be excluded from aggressive injury treatment based on age alone.

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Title: Geriatric polytrauma patients should not be excluded from aggressive injury treatment based on age alone
Authors: Karlijn J. P. van Wessem
Luke P. H. Leenen
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Central Nervous System Trauma
Polytrauma
Acute Respiratory Distress-Syndrome
Polytrauma
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01567-y

At a glance: The STEP trials

Springer Medicine

Geriatric polytrauma patients should not be excluded from aggressive injury treatment based on age alone

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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