All Patients with Trauma
Figure 1 showed the study profile. In 2016, the number of citizens living in the city of study hospital was 1,886,033[18]. We thus used citizens as the analysis unit to estimate the incidence of trauma in various age intervals. Of all hospitalized patients, the geriatric group had a higher incidence of trauma than did the nongeriatric group (1.1/1000 vs. 0.5/1000). Additionally, we observed that the incidence of trauma increased with age (65–74 years vs. 75–84 years vs. ≥85 years: 1.0/1000 vs. 1.4/1000 vs. 2.9/1000). This incidence of trauma is illustrated in Figure 2.
Table 1 presents a comparison of all geriatric and nongeriatric patients with trauma in terms of demographic characteristics. Except for age, The geriatric and nongeriatric groups exhibited similar sex distributions and proportions of patients with a Charlson comorbidity index of >0. Regarding prehospital conditions (location of injury, mechanism of injury, and time of transportation from the site of injury to the hospital), we observed that the geriatric group was associated with a longer time of transportation from the site of injury to the ED compared with the nongeriatric group. Concerning vital signs and triage in the ED, we found no differences between the geriatric and nongeriatric groups, except for respiratory rate, which was lower in the geriatric group.
The geriatric and nongeriatric groups also exhibited similar distributions with respect to region of injury. The geriatric group had a higher Injury Severity Score and New Injury Severity Score than did the nongeriatric group. However, the geriatric and nongeriatric groups exhibited similar Revised Trauma Scores and Trauma Injury Severity Scores. The average values of all laboratory test parameters were within normal limits for the geriatric and nongeriatric groups, except for the average white blood cell count, which was elevated in these two groups. We observed significant differences in potassium and glucose levels between the geriatric and nongeriatric groups. Other laboratory test parameters were similar between the two groups.
Fewer geriatric patients underwent surgery during their hospitalizations than nongeriatric patients (65.9% vs. 70.7%, p = 0.000). Other management procedures and hospital courses were similar between the geriatric and nongeriatric groups.
Patients with Severe Trauma (Injury Severity Score > 15)
Table 2 presents a comparison of geriatric and nongeriatric patients with severe trauma in terms of demographic characteristics. This subgroup analysis included 58 and 128 geriatric and nongeriatric patients, respectively. Except for age, The geriatric and nongeriatric groups exhibited similar sex distributions and percentages of patients with a Charlson comorbidity index of >0, we discovered that the geriatric group had a higher proportion of patients transferred from other hospitals than did the nongeriatric group.
We noted no differences between the geriatric and nongeriatric groups with respect to vital signs and triage in the ED except for respiratory rate, which was lower in the geriatric group.
Furthermore, the geriatric and nongeriatric groups exhibited similar distributions with respect to region of injury. The geriatric group had higher Injury Severity Score and New Injury Severity Score and lower Trauma Injury Severity Score than did the nongeriatric group. However, the two groups exhibited similar Revised Trauma Scores.
The values of three laboratory test parameters differed significantly between the geriatric and nongeriatric groups. Specifically, the geriatric group had higher levels of hemoglobin, creatinine, and alanine transaminase.
Fewer geriatric patients underwent surgery than did nongeriatric patients (27.6% vs. 44.5%, p = 0.028). Other managements and hospital courses were similar between the geriatric and nongeriatric groups.
Prognosis
Figure 3 summarizes the prognosis of all patients. We observed an increase in mortality with age (all patients with trauma: 18–64 years vs. 65–74 years vs. 75–84 years vs. ≥85 years: 1.8% vs. 4.8% vs. 5.0% vs. 8.3%; patients with severe trauma: 18–64 years vs. 65–74 years vs. 75–84 years vs. ≥85 years: 9.4% vs. 18.5% vs. 22.2% vs. 33.3%). Figure 3 illustrates the observed incidence and mortality in different age groups in our study populations.
Comparing the geriatric and nongeriatric groups, the geriatric group had a higher mortality rate and less need for long-term care (mortality: 5.5% vs. 1.8%; long-term care: 2.2% vs. 5.0%; recovery: 92.3% vs. 93.0%; acute transfer: 0.0% vs. 0.2%, p = 0.005). The difference in mortality between the geriatric and nongeriatric group was greater in severe trauma (22.4% vs. 9.4%, p=0.046). Regarding complication rates, geriatric patients and nongeriatric patients in this study showed similar complication rates.
Patients Who Underwent Surgery
We discovered that the geriatric trauma patients had a lower surgical rate compared to nongeriatric patients; such difference was greater in severe trauma cases and might contributed to the prognostic differences between the two groups. Therefore, we selected all patients who had undergone surgery and divided them into geriatric (184 patients) and nongeriatric (465 patients) groups to compare their trauma severity, resource requirements, and prognosis (Table 3). The geriatric group had a lower percentage of patients with multiple trauma (defined as patients with an Injury Severity Score of >2 in two regions) than did the nongeriatric group; however, the difference did not reach statistical significance (geriatric group vs. nongeriatric group: 3.8% vs. 7.5%, p = 0.082). Furthermore, the geriatric group included fewer patients who sustained severe injuries in the head and neck regions (defined as an Abbreviated Injury Scale >2 in the head and neck regions) than did the nongeriatric group (20.0% vs. 42.3%, p = 0.000). The need for intensive care and the need for life-saving procedures were comparable between the geriatric and nongeriatric groups; nevertheless, the geriatric group had higher proportions of patients who died, required long-term care, and had complications than did the nongeriatric group (mortality: 3.8% vs. 1.3%; long-term care: 9.8% vs. 1.7%; recovery: 85.9% vs. 95.9%, p = 0.000; complication: 3.8% vs. 3.2%, p = 0.000).