Survivorship After High-Energy Geriatric Trauma

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Objectives:To evaluate in-hospital, 1-year, and 5-year survivorship of geriatric patients after high-energy trauma, to compare survivorship of geriatric patients who sustained high-energy trauma with that of those who sustained low-energy trauma, and to identify predictors for mortality.Design:Retrospective.Setting:Urban Level I trauma center.Patients:Study group of 1849 patients with high-energy trauma and comparison group of 761 patients with low-energy trauma.Intervention:Each patient was observed from the time of index admission through the end of the study period or until death or readmission.Main Outcome Measurement:Long-term survivorship based on the Social Security Death Index.Results:Survivorship between patients with high-energy and low-energy injuries was statistically significant. Among patients who sustained high-energy injuries, in-hospital mortality was 8%, 1-year mortality was 15%, and 5-year mortality was 25%. Among patients who sustained low-energy injuries, in-hospital mortality was 3%, 1-year mortality was 23%, and 5-year mortality was 40%. Low-energy mechanism of injury was an independent predictor for 1-year and 5-year mortality, even when controlling for Charlson Comorbidity Index (CCI), Injury Severity Score (ISS), age, sex, body mass index (BMI), and admission Glasgow Coma Scale (GCS) score.Conclusions:Geriatric patients with high-energy injuries and those with low-energy injuries seem to represent different patient populations, and low-energy mechanism seems to be a marker for frailty. High-energy mechanism was associated with lower long-term mortality rates, even when controlling for CCI, ISS, age, sex, BMI and admission GCS score.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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