@article{ref1,
title="Predictors of mortality among older major trauma patients",
journal="Canadian journal of emergency medicine",
year="2023",
author="Yadav, Krishan and Lampron, Jacinthe and Nadj, Richard and Raichura, Rikesh and Figueira, Sonshire and Nemnom, Marie-Joe and Taljaard, Monica and Emond, Marcel and Benhamed, Axel and Eagles, Debra",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Older trauma patients have a higher mortality yet are more likely to be under-triaged compared to younger patients. Studies have suggested that current trauma team activation criteria are suboptimal for older patients. <br><br>OBJECTIVES: The objective was to describe trauma care delivered, patient outcomes, and to identify variables independently associated with mortality. <br><br>METHODS: We performed a health records review from 2014 to 2020 of older (age ≥ 65 years) trauma patients presenting to a level one trauma centre with any of the following: injury severity score (ISS) > 12, and all trauma team activations or admission to the trauma ward. The primary outcome was 30-day all-cause mortality. Secondary outcomes included injury mechanism and trauma care delivered. Multivariable logistic regression was used to identify factors independently associated with 30-day all-cause mortality. Multiple imputation was used to deal with missing data. <br><br>RESULTS: We enrolled 1,380 patients (mean age 80 years, mean ISS 18); 26.8% had multimorbidity (≥ 2 chronic conditions) and 65.9% met criteria for polypharmacy (≥ 5 medications). The most common mechanism was fall from standing height (61.1%). Thirty-day all-cause mortality occurred in 239 (17.3%) patients. A Glasgow coma scale (GCS) < 15 (odds ratio [OR] = 5.55; 95% CI 3.73-8.24), ISS > 15 (OR = 3.75, 95% CI 2.35-6.01), age ≥ 85 years (OR = 2.04, 95% CI 1.29-3.22), anticoagulation with a direct oral anticoagulant (DOAC) or warfarin (OR = 1.59, 95% CI 1.08-2.35) and multimorbidity (OR = 1.53, 95% CI 1.06-2.22) were significantly associated with increased risk 30-day mortality (C-statistic = 0.82, 95% CI 0.79-0.85). Dementia (OR = 0.61, 95% CI 0.40-0.95) and time to CT scan > 60 min (OR = 0.50, 95% CI 0.34-0.74) were associated with decreased mortality risk. <br><br>CONCLUSION: We identified five factors associated with increased 30-day mortality in older trauma patients: GCS < 15, ISS > 15, age ≥ 85 years, anticoagulation, and multimorbidity. These factors should be considered when developing modified trauma team activation criteria for older adults.<p /> <p>Language: en</p>",
language="en",
issn="1481-8035",
doi="10.1007/s43678-023-00597-w",
url="http://dx.doi.org/10.1007/s43678-023-00597-w"
}