客观亚洲正在以无与伦比的速度向人口老龄化转变。这会影响创伤的特征和结果。我们旨在研究与年轻成人创伤患者相比,老年成人创伤患者的不同特征,并描述影响亚洲国家预后的因素。方法这是一个回顾性的,国际,在泛亚创伤结果研究(PATOS)注册中参与中心的创伤多中心研究,其中包括年龄≥18岁的创伤病例,从2015年10月至2018年11月通过紧急医疗服务(EMS)带到急诊科(ED)。对老年人(≥65岁)和年轻人(<65岁)的数据进行分析和比较。主要结局指标是住院死亡率,次要结果是出院时的残疾,医院和重症监护病房(ICU)住院时间。结果39,804例创伤患者,10,770(27.1%)为老年人。老年女性的创伤发生率更高(54.7%vs33.2%,p<0.001)。老年人跌倒更频繁(66.3%vs24.9%,p<0.001),与年轻的成年创伤患者相比,平均损伤严重程度评分(ISS)也较高(5.4±6.78vs4.76±8.60,p<0.001)。老年成人创伤患者的不良GOS发生率更高(13.4%vs4.1%,p<0.001),更高的医院死亡率(1.5%vs0.9%,p<0.001)和更长的中位住院时间(12.8vs9.8,p<0.001)。多因素logistic回归分析显示年龄(AOR1.06,95CI1.02-1.04,p<0.001),男性(AOR1.60,95CI1.04-2.46,p=0.032),头部和面部损伤(AOR3.25,95CI2.06-5.11,p<0.001),腹部和骨盆损伤(AOR2.78,95CI1.48-5.23,p=0.002),心血管(AOR2.71,95CI1.40-5.22,p=0.003),肺(AOR3.13,95CI1.30-7.53,p=0.011)和癌症(AOR2.03,95CI1.02-4.06,p=0.045)合并症,严重ISS(AOR2.06,95CI1.23-3.45,p=0.006),格拉斯哥昏迷评分(GCS)≤8(AOR12.50,95%CI6.95-22.48,p<0.001)是住院死亡率的重要预测因素。结论亚洲地区老年创伤患者死亡率高于年轻患者,有许多重要的预测因素。这些发现说明了老年创伤患者的不同特征及其影响结果的潜力。老年创伤的预防措施应根据这些因素有针对性。
Asia is experiencing a demographic shift toward an aging population at an unrivaled rate. This can influence the characteristics and outcomes of trauma. We aim to examine different characteristics of older adult trauma patients compared to younger adult trauma patients and describe factors that affect the outcomes in Asian countries.
This is a retrospective, international, multicenter study of trauma across participating centers in the Pan Asian Trauma Outcome Study (PATOS) registry, which included trauma cases aged ≥18 years, brought to the emergency department (ED) by emergency medical services (EMS) from October 2015 to November 2018. Data of older adults (≥65 years) and younger adults (<65 years) were analyzed and compared. The primary outcome measure was in-hospital mortality, and secondary outcomes were disability at discharge and hospital and intensive care unit (ICU) length of stays.
Of 39,804 trauma patients, 10,770 (27.1%) were older adults. Trauma occurred more among older adult women (54.7% vs 33.2%, p < 0.001). Falls were more frequent in older adults (66.3% vs 24.9%, p < 0.001) who also had higher mean Injury Severity Score (ISS) compared to the younger adult trauma patient (5.4 ± 6.78 vs 4.76 ± 8.60, p < 0.001). Older adult trauma patients had a greater incidence of poor Glasgow Outcome Scale (GOS) (13.4% vs 4.1%, p < 0.001), higher hospital mortality (1.5% vs 0.9%, p < 0.001) and longer median hospital length of stay (12.8 vs 9.8, p < 0.001). Multiple logistic regression revealed age (adjusted odds ratio [AOR] 1.06, 95%CI 1.02-1.04, p < 0.001), male sex (AOR 1.60, 95%CI 1.04-2.46, p = 0.032), head and face injuries (AOR 3.25, 95%CI 2.06-5.11, p < 0.001), abdominal and pelvic injuries (AOR 2.78, 95%CI 1.48-5.23, p = 0.002), cardiovascular (AOR 2.71, 95%CI 1.40-5.22, p = 0.003), pulmonary (AOR 3.13, 95%CI 1.30-7.53, p = 0.011) and cancer (AOR 2.03, 95%CI 1.02-4.06, p = 0.045) comorbidities, severe ISS (AOR 2.06, 95%CI 1.23-3.45, p = 0.006), and Glasgow Coma Scale (GCS) ≤8 (AOR 12.50, 95%CI 6.95-22.48, p < 0.001) were significant predictors of hospital mortality.
Older trauma patients in the Asian region have a higher mortality rate than their younger counterparts, with many significant predictors. These findings illustrate the different characteristics of older trauma patients and their potential to influence the outcome. Preventive measures for elderly trauma should be targeted based on these factors.