The majority of studies on elderly trauma patients have included all elderly trauma patients, and we propose that relying on estimates from studies assessing all elderly trauma patients may be misleading.
Gowing and Jain [2] reviewed 125 elderly trauma patients with an ISS > 12 assessed at a Canadian institution, only 14 of whom required ICU admission.
The in- hospital mortality rate for this population was 26%, and 33% of patients were discharged home. Similarly, Richmond et al described outcomes of over 38 000 elderly trauma patients requiring ICU admission, surgical intervention or who had a length of stay after trauma of greater than 72 hours using data from the Pennsylvania state trauma registry [6].
They described a 10% mortality, and amongst survivors, a greater than 50% rate of discharge home.
Finally, Fererra and colleagues prospectively assessed 239 trauma patients, and found 81% returned to a functional level or back to baseline [10].
Studies such as these have been used to argue for aggressive treatment in elderly trauma patients.
However, our results suggest that this may not be the case.
Miller and colleagues assessed 115 trauma patients requiring prolonged ICU stay to determine functional outcomes at 3 months post-discharge [15].
In line with our results, amongst the 24 patients over the age of 75, 14 survived to hospital discharge, and of these, only 2 were discharged home.
Our results showed that less than one-quarter of patients were discharged home.
It is important to convey to decision makers not only prognosis with respect to mortality, but also data such as these, which highlight the potentially significant morbidity and loss of prior independence.
The majority of studies on elderly trauma patients have included all elderly trauma patients, and we propose that relying on estimates from studies assessing all elderly trauma patients may be misleading. Gowing and Jain [2] reviewed 125 elderly trauma patients with an ISS > 12 assessed at a Canadian institution, only 14 of whom required ICU admission. The in- hospital mortality rate for this population was 26%, and 33% of patients were discharged home. Similarly, Richmond et al described outcomes of over 38 000 elderly trauma patients requiring ICU admission, surgical intervention or who had a length of stay after trauma of greater than 72 hours using data from the Pennsylvania state trauma registry [6]. They described a 10% mortality, and amongst survivors, a greater than 50% rate of discharge home. Finally, Fererra and colleagues prospectively assessed 239 trauma patients, and found 81% returned to a functional level or back to baseline [10]. Studies such as these have been used to argue for aggressive treatment in elderly trauma patients. However, our results suggest that this may not be the case. Miller and colleagues assessed 115 trauma patients requiring prolonged ICU stay to determine functional outcomes at 3 months post-discharge [15]. In line with our results, amongst the 24 patients over the age of 75, 14 survived to hospital discharge, and of these, only 2 were discharged home. Our results showed that less than one-quarter of patients were discharged home. It is important to convey to decision makers not only prognosis with respect to mortality, but also data such as these, which highlight the potentially significant morbidity and loss of prior independence.
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