ABSTRACT
OBJECTIVES: To study mortality and functional outcome in elderly patients suffering major trauma and to assess whether age affects prognosis. DESIGN AND SETTING: Retrospective identification of patients from the Royal North Shore Hospital, a level three trauma service and teaching hospital of the University of Sydney. The patients were followed up for an average of three years after admission. PATIENTS: One hundred and eighteen patients aged over 60 years, with injury severity scores over 15, admitted consecutively between May 1988 and July 1990. To determine the effects of age on outcome, patients were divided into two groups: those aged 61-70 years (67 patients) and over 70 years (51 patients). MAIN OUTCOME MEASURES: Death in hospital, late death after discharge, change in preinjury v. current accommodation and current functional ability, measured with the Barthel activities of daily living index. RESULTS: Thirty-six of the 118 patients died in hospital. Eighty-one of the remaining 82 patients were followed up. Twenty-five of these patients died during the study period: three in the 61-70 years age group, and 22 in the over 70 years age group (P < 0.0001). Among the long term survivors, 43 of 53 continued to live independently, and 41 of 54 scored maximum points in activities of daily living assessment. Only seven people required nursing home care. CONCLUSIONS: Age is an important factor in survival after major trauma, but those that do survive generally return to full activity and independence. Aggressive treatment for elderly trauma victims is warranted.
Subject(s)
Activities of Daily Living , Geriatric Assessment , Multiple Trauma/mortality , Multiple Trauma/physiopathology , Treatment Outcome , Age Factors , Aged , Cause of Death , Discriminant Analysis , Follow-Up Studies , Hospital Mortality , Hospitals, Teaching/statistics & numerical data , Humans , Injury Severity Score , Length of Stay/statistics & numerical data , Middle Aged , Multiple Trauma/classification , Multiple Trauma/therapy , New South Wales , Prognosis , Retrospective Studies , Survival RateABSTRACT
Blunt thoracic aortic rupture (TAR) initially presents with subtle signs but is usually fatal if not diagnosed and treated early. Does the diagnostic process affect outcome? The definitive test most widely promoted is thoracic (arch) aortography but is usually only available in major teaching hospitals. Thoracic computerized tomography (CT) scanning is more readily available but its role in diagnosis of TAR is unproven. A retrospective review of trauma databases and medical record indexes over a 7 year period identified 38 patients presenting with TAR at Westmead and Royal North Shore Hospitals in the period 1984-91. Thirteen patients (34%) were dead on arrival or died within 15 min of arrival at either hospital. Five patients (13%) who arrived in cardiac arrest (with suspected TAR) died after immediate thoracotomy (two in the Emergency Department and three in the operating room). Two patients (5%) died from severe head injuries and were not investigated for TAR. Eighteen patients (47%) remained alive long enough for investigation and were considered potentially salvageable. Nine of these survived. Only 13 patients had arch aortography. No patient survived without an aortogram. Five patients had a chest CT scan; aortography followed in four patients. Computerized tomography scans delayed aortography or were misinterpreted. Review of all trauma thoracic (arch) aortograms for the same period at Westmead Hospital revealed a diagnosis of TAR in 7.4%. Blind thoracotomy did not result in survival. Computerized tomography scanning of the chest was of no value in the management of this injury. Early suspicion of possible thoracic aortic rupture demands urgent arch aortography and this remains the diagnostic 'gold standard'.
