Major trauma in young and old: What is the difference?

Objective: To evaluate the differences in mortality and longterm outcome between young and elderly patients with multiple injuries.

Design: Retrospective and descriptive.

Materials and Methods: Over a 5-year period (from January 1985 to January 1990) all the consecutive young (20 to 29 Sears, n = 167) and elderly (greater than or equal to 60 years, n = 121) patients with an Abbreviated Injury Scale score/Injury Severity Score of greater than or equal to 16 treated at the University Hospital Groningen (the Netherlands) were reviewed. Age, sex, mechanisms of injury. Abbreviated Injury Scale score, Injury Severity Score, mortality, duration of artificial ventilation, hospitalization, and intensive care treatment and discharge destination were analyzed. Long-term outcome was determined using the Glasgow Outcome Scale.

Measurements and Main Results: Motorized vehicles were the leading cause of injury in both groups. Mortality in the young was lower than in the elderly (19.6% versus 38.8%); all elderly with an Injury Severity Score of greater than or equal to 50 died. Nearly all deaths in young and elderly were caused by severe brain injuries (83.8% versus 74.4%), Deaths related to multiple organ failure were not observed in the young and were rare in the elderly. The surviving young and elderly could be discharged home in equal percentages and their functional outcome 2 years after injury did not differ essentially.

Conclusion: We did not find any valid argument to treat severely injured elderly patients any differently from their younger counterparts, which implies that the increased trauma care cost is also justified for severely injured elderly.