Injury patterns and patient outcomes of abdominal trauma in the elderly population: a 5-year experience of a Major Trauma Centre.

Abstract

Introduction: The management of abdominal trauma in older patients is challenging due to preexisting comorbidities, impaired physiology, frailty and atypical clinical presentations. Few studies focus on the characteristics of abdominal trauma in older populations.

Methods: A retrospective service evaluation was conducted during the period January 2017 - December 2022 at University Hospital Southampton, the designated Major Trauma Centre (MTC) of Wessex Trauma Network in the United Kingdom. Data was collected from the local Trauma Registry. Patients aged ≥ 65 years old and with Abbreviated Injury Scale (AIS) over one for the Abdomen were included. Patients aged less than 65 years old and those who died on arrival to the MTC were excluded.

Results: Out of 4977 geriatric trauma patients, only 150 cases (3%) were eligible, with a mean age of 77 years and a median Injury Severity Score of 22. The trauma team activation code was triggered in just under half of all cases (49%). All-level falls were the leading mechanism (52%) and low-energy falls were significantly higher in patients aged ≥ 85 years (P <0.001). The spleen was the most frequently affected organ (27%). About 47% of abdominal injuries were severe (AIS Abdomen ≥3) and about 22% of patients required surgical or radiological intervention. Three patients sustained occult abdominal injuries and one of them had a negative CT scan initially. The overall 30-day mortality rate was 20%. Of all casualties, most were polytrauma cases (87%).

Conclusion: Despite the low incidence of abdominal injuries in the elderly, when these occurred, almost half were serious with AIS Abdomen ≥ 3 and almost one in four required surgical or radiological intervention. The use of single-time imaging may not be sufficient to ensure the absence of injury, as delayed manifestations of occult abdominopelvic trauma may occur. Close monitoring and regular reassessments are recommended, even with a negative CT scan on arrival. The high all-cause mortality rate may correlate with the high incidence of polytrauma in this cohort and the failure to trigger a trauma call in the Emergency Department. Future studies should focus on the development of triage tools and include the use of validated and designated frailty tools for larger population analysis.