Authors (including presenting author) :
Yeung JHH (1), Chang MLA (2), Leung PSM (3), Wong HTH (4), Wong KSJ (5), Cheung NK (6) Graham CA (7)
Affiliation :
(1)Trauma Service (TS), Princess Margaret Hospital (PMH); (2) TS, Queen Elizabeth Hospital (QEH); (3) Accident and Emergency Department (AED), North Lantau Hospital; (4) TS, Queen Mary Hospital (QMH); (5) AED, The Chinese University of Hong Kong (CUHK) Medical Centre (6) AED, Prince of Wales Hospital (PWH); (7) Accident and Emergency Medicine Academic Unit, CUHK.
Introduction :
Hong Kong (HK) had the highest life expectancy but the mortality were high among elderly trauma patients. Fall was the leading cause of trauma of elderly and it posed a huge challenge to the healthcare providers. The elderly’s comorbidities, vital signs, injury causes, pattern and severity, and related mortality were different to young people which was important to guide the management and treatment.
Objectives :
To describe the epidemiology, common injuries, specify TBI, major injury patterns, vital sings related mortality and the trend in older trauma patients. And secondly to identify predictors of mortality to facilitate nursing assessment, triage and treatment pathways and ultimately lead to improvements in patient outcomes.
Methodology :
This is a ten-year retrospective trauma registry study of five trauma centers (PWH, QEH, PMH, TMH, QMH). Study period from 01/01/2019 to 31/12/2020. Inclusion criteria: aged 55 or above, and were triaged as category I or II, ICU/HDU admission, or primary or secondary diversion, or trauma death. The primary outcome was mortality. Chi-square test, linear –by- linear association and fisher’s exact test were used for categorical data and t-test was used for continuous data.
Result & Outcome :
There were 8205 patients aged 55 to 109 years met the inclusion criteria and entered to the study. The mean age was 74.9 years and 72.6% had co-morbidities. The patients increased 1.86 times in 10 years The mortality rate on age 50-59 years was 5.1 % and it increased to 17.8% on patient older than 80 years. 3373 (41.1%) injured at home and 1087(23%) injured as the result of road trauma. 1256 (15.3%) were admitted on 00:00-08:00 and their had significant higher mortality rate (P=0.004). 1210(14.7%) were multiple trauma and 4520 (55.0%) were major trauma (ISS>15). 5014(61.1%) had traumatic brain injury (TBI) and 3398 (41.4%) had subdural hematoma (SDH) which was most common TBI. The mortality of patients with SDH >1cm was 42.1%. However, 58% SDH patient with full GCS and even 43.3% SDH>1cm patient had normal GCS. In elderly, not only hypotension patient but also BP>180 mmHg patient had higher mortality (P<0.001). Second common injury was hip fracture 832 (10.1%). 711 (8.7%) had thoracic injury and 2/3 of them had associated injuries. Conclusion: Fall trauma patients were increasing and TBI was the most common injuries and the causes of death. The results of this study provided very important information and characteristic of elderly trauma for nursing triage, observation, health care planning and management and injury prevention.
