OTA 2005 Posters
Scientific Poster #1 Geriatrics and Reconstruction
Outcome of Multiple Trauma Patients 65 and Older with Orthopedic Injuries
Purpose: People 65 years of age or older are the fastest growing segment of the population in the United States. Although they currently constitute only 12% of the population, the elderly consume 33% of resources spent on trauma care. With the improved survival rates and emphasis on functional outcomes, the elderly patient population with multiple trauma injuries is an increasingly important focus of injury research. Because the current literature does not address the long-term outcome of multiple trauma elderly patients with orthopedic injuries, this study was conducted to examine the outcome in elderly patients with multiple trauma and orthopaedic injuries.
Methods: The trauma registry of a level 1 trauma center was queried to identify geriatric patients (age 65 years) admitted between 1995 and 2002 with an Injury Severity Score (ISS) 16 and concurrent, serious orthopaedic injuries (AIS 3). Patient charts were reviewed after approval of the Institutional Review Board. Ninety-four adult patients with an average age of 71 years (range, 65 to 96) and an average ISS of 25 (range, 17 to 59) were treated for multiple trauma with orthopaedic injuries. The mechanisms of injury were motor vehicle crash (57%), pedestrian-struck (25%), falls (13%), and other (5%). Multiple data points were collected, including past medical history, nonorthopaedic injuries and treatment, length of stay (LOS) in intensive care, number of days on ventilator, total LOS, discharge destination, as well as details of all orthopaedic injuries. All fractures were classified according to OTA classification. The majority of sites for orthopaedic injury included the tibia (n=33), femur (31), pelvis and acetabulum (28), and spine (15). Significant nonorthopaedic injuries included 11 subarachnoid hemorrhages, 15 pneumothoraces, 7 hemothoraces, 14 cases with multiple rib fractures, and 9 visceral injuries. The RAND 36-Item Health Survey was used to evaluate the long-term impact on functional outcome and quality of life for surviving patients. Univariate and multivariate statistical analysis was completed. All P values were calculated using a student's t-test.
Results: The study group had a mean ICU and hospital LOS of 11 and 20 days, respectively, and a mortality rate of 33%. The nonsurvivors had an average age of 71 years and ISS of 26. The patients requiring operation for their nonorthopaedic injuries had significantly greater LOS in intensive care (12 days longer), ventilator days (5 days longer), and mortality (37% vs. 20%); all P values were <0.05). Compared to the patients with a single orthopaedic injury, those with multiple fractures also had significantly longer ICU LOS (5 days longer), hospital LOS (9 days longer), and mortality (33% vs. 23%); all P values were <0.05. Pelvic fractures were associated with a mortality rate of 42%. Of surviving patients, only 19% were discharged home initially. On follow-up, the RAND 36 demonstrated a decrease in physical functioning with comparatively less effect on emotional well-being and social functioning.
Discussion: Current literature has demonstrated mortality rates in the geriatric multiple trauma population (without accounting for nonpelvic orthopaedic injuries) ranging from 17% to 22%. Our patient population had a mortality rate of 33%, demonstrating the significant effect orthopaedic injury has on the outcome of the geriatric multiple trauma patients. The need for surgical intervention for nonorthopaedic injuries, as well as pelvic and/or multiple fractures, prolongs LOS and increases mortality. Data from follow-up in this population suggests decrease in physical functioning has the greatest impact on quality of life. Results from the study can be applied to maximizing the management of therapeutic intervention and be included in family discussions for this rapidly growing patient population.