目的:我们对不断增长的老年人群创伤后结局的危险因素的理解仍不完全。这项研究旨在比较年轻和老年患者严重孤立性钝性胸部创伤的结果,并评估死亡率的预测因素。
方法:ACS-TQIP2017-2020数据库用于识别严重孤立性钝性胸部创伤患者。有胸外损伤的病人,向急诊科(ED)介绍时没有生命迹象,院前心脏骤停,或被转移到其他医院或从其他医院转移的人被排除在外。主要结果是院内死亡率。进行单变量和多变量回归分析以评估死亡率的独立预测因子。
结果:总共189,660名患者被纳入研究,年龄中位数为58岁;37.5%的人年龄在65岁或以上,1.9%因出院死亡。65岁及以上的患者死亡率明显较高(3.4%vs.1.0%,p<0.001)和总体并发症(7.0%vs.4.7%,p<0.001)与年轻患者相比。年龄≥65岁与死亡率独立相关(OR:5.45,95CI:4.96-5.98,p<0.001),住院时间延长,和并发症。在老年组,与年龄65~75岁相比,年龄>75岁是死亡率的独立预测因子(OR:2.62,95CI:2.37~2.89,p<0.001).患有MVC的老年患者,GCS≤8,SBP<90的患者死亡率最高,为56.9%.
结论:与年轻患者相比,患有孤立性严重钝性胸部损伤的老年创伤患者的死亡率和发病率明显更高,需要特别考虑影响预后的多种因素。死亡率的个体预测因子对老年患者的死亡率具有更大的影响。
OBJECTIVE: Our understanding of the growing geriatric population\'s risk factors for outcomes after traumatic injury remains incomplete. This study aims to compare outcomes of severe isolated blunt chest trauma between young and geriatric patients and assess predictors of mortality.
METHODS: The ACS-TQIP 2017-2020 database was used to identify patients with severe isolated blunt chest trauma. Patients having extra-thoracic injuries, no signs of life upon presentation to the emergency department (ED), prehospital cardiac arrest, or who were transferred to or from other hospitals were excluded. The primary outcome was in-hospital mortality. Univariate and multivariable regression analyses were performed to assess independent predictors of mortality.
RESULTS: A total of 189,660 patients were included in the study, with a median age of 58 years; 37.5% were aged 65 or older, and 1.9% died by discharge. Patients aged 65 and older had significantly higher mortality (3.4% vs. 1.0%, p < 0.001) and overall complications (7.0% vs. 4.7%, p < 0.001) compared to younger patients. Age ≥ 65 was independently associated with mortality (OR: 5.45, 95%CI: 4.96-5.98, p < 0.001), prolonged hospitalization, and complications. In the geriatric group, age > 75 was an independent predictor of mortality compared to ages 65-75 (OR: 2.62, 95%CI: 2.37-2.89, p < 0.001). Geriatric patients with an MVC, presenting with a GCS ≤ 8, and having an SBP < 90 had the highest mortality of 56.9%.
CONCLUSIONS: The geriatric trauma patient with isolated severe blunt chest injury has significantly higher mortality and morbidity compared to younger patients and warrants special consideration of multiple factors that affect outcomes. Individual predictors of mortality carry a greater impact on mortality in geriatric patients.