Risk Factors Associated With Worse Outcomes in Trauma Patients Aged 55 and Older.

Abstract

Background: Prior studies have shown an increase in mortality in trauma patients after 55 years of age. However, it is less certain which pre-existing comorbidities (PECs) are associated with poorer outcomes. The purpose of this study was to identify the risk factors associated with poor outcomes and death in patients 55 years old and older admitted for trauma.

Methods: Trauma patients (age ≥ 55) were studied retrospectively from the local trauma registry at HCA Florida Kendall Hospital, a level 1 trauma center (2020-22). We collected the subject's age, gender, PECs, and outcome data. Then we performed multiple logistic regression to assess which PECs were associated with in-hospital mortality, acute kidney injury (AKI), ventilator-associated pneumonia (VAP), and unplanned intensive care unit (ICU) admission.

Results: We identified 5168 trauma patients 55 years old and older, of which 54.9% were female. Chronic renal failure (CRF) increased the odds of in-hospital mortality (adjusted odds ratio [aOR] = 2.30, P < .001), unplanned ICU admission (aOR = 1.73, P = .033), and AKI (aOR = 2.97, P < .001). Congestive heart failure (CHF) increased the odds of in-hospital mortality (aOR = 1.75, P < .001), unplanned ICU admission (aOR = 2.64, P < .001), and VAP (aOR = 2.42, P = .047). Cirrhosis increased the odds of in-hospital mortality (aOR = 3.78, P = .007), unplanned ICU admission (aOR = 3.11, P = .007), and AKI (aOR = 3.78, P = .007).

Conclusion: Our analysis showed an association between certain comorbidities and poor outcomes in geriatric trauma patients 55 years old and older; namely, CRF, CHF, and cirrhosis were linked to increased in-hospital mortality, unplanned ICU admission, and the development of complications. Identifying these risk factors can aid in developing protocols to improve monitoring and complication-reduction strategies.