The outcome following major trauma in the elderly. Predictors of survival.

Abstract

To assess the reliability of the predicted probability of survival calculated using TRISS methodology by the UK Trauma Network for elderly patients. Analysis of 100 consecutive trauma patients 65 years and over, prospectively entered into the UK Trauma Network database from a single centre. The probability of survival (Ps) was calculated from the UK Trauma database and retrospectively related to survival, premorbid medical condition and mobility. Of 100 patients, 16 died and 84 survived. Eleven of the 16 who died and 12 of the survivors had pre-existing medical disease (ASA grade III-V) and social dependency suggesting a poor outcome, these factors being significantly associated with mortality (P < 0.005). The mean Ps for the 11 with severe medical disease who died was 0.85 (+/- 0.07) with a mean age 85 (+/- 3.5). The remaining five patients who died suffered high energy injuries, had a mean age of 70 (+/- 4.8) and a low probability of survival (Ps 0.40 +/- 0.24). The median pre-injury mobility score was 8 in patients who survived and 4.5 in those who died. Mobility score < 5 was associated with an increased mortality following admission from Trauma (P < 0.05). There is a significant association between severe preexisting medical disease (ASA III-V) and death during admission for trauma. The Ps score is unrealistically high in this group of patients. A simple mobility score correlates well with outcome in this group.