Outcome from Critical Care in the ``Oldest Old'' Trauma Patients

Publisher Website
Google Scholar
Abstract
This study evaluated the ``oldest old'' Intensive Care Unit (ICU) trauma patients, defined as patients of age 75 and over, to determine the relationships between age, injury magnitude, physiologic severity of illness, and outcome in this group, compared with younger trauma patients. Of 1,039 consecutive Surgical ICU (SICU) patients with complete data, 45 were in the Oldest group, 54 were in the Elderly group (ages 65 to 74), and 940 were in the Younger group (age < 65). Age, sex, and type of trauma (penetrating versus blunt) did not predict outcome. The Injury Severity Score (ISS) was significantly higher in the Oldest group than in the other groups (p = 0.0005), but the Trauma Score was the same for all groups. The proportion of Oldest group patients with ISS greater than or equal to 20 was significantly higher than for Elderly and Younger group patients (p = 0.0002 and p < 0.00005, respectively). The Simplified Acute Physiology Score (SAPS) on the first SICU day was the best outcome predictor for all age groups, along with maximum SAPS during the SICU stay (p < 0.00005 for both). When patients were stratified by ISS, there was a statistically significant difference in day 1 SAPS among age groups for most ISS categories, with higher SAPS associated with advancing age. The oldest old fare worse with trauma because their injury is more severe (higher ISS) and because their physiologic response to a given level of injury is exaggerated (higher SAPS). However, once the oldest old are stratified by SAPS, their outcome parallels that of their younger trauma cohorts. This study indicates that specific treatment protocols for the oldest old trauma patients are indicated. Once these patients reach the SICU, decisions regarding outcome should be based on severity of illness rather than age, trauma type, or injury severity.

This publication has 17 references indexed in Scilit: