CHICAGO – Long-term survival in severely injured geriatric trauma patients may not be as poor as once thought, according to a study at a level 1 trauma center in Pennsylvania that followed these patients for up to 10 years after discharge.
The retrospective study presented at the annual meeting of the American Association for the Surgery of Trauma showed an overall death rate of 33% in elderly patients with brain injury, and almost two-thirds of the patients who survived their initial hospitalization were alive at the conclusion of the study, according to Dr. Ulunna Ofurum of St. Luke’s Hospital in Bethlehem, Pa.
Dr. Ulunna Ofurum
Dr. Ofurum and her colleagues undertook their study to learn whether aggressive care in this population was futile. Trauma patients aged 65 and older with an Injury Severity Score of 30 or higher were assigned to two groups based on the presence or absence of brain injury, with an Abbreviated Injury Scale score of 3 or higher as the cutoff. The Social Security Death Index database was used to determine survival status.
"The initial drop in survivorship was most pronounced in the patients with severe head injury," she said. Overall, 97 of the 145 patients survived hospital discharge, but nearly a third died after hospital discharge. That left 65 for analysis of current living status, Dr. Ofurum said. Of those, 52 patients in the head-injured group had a median survival of 33 months, and 13 of the patients without head injury had a median survival of 49 months.
Of the 65 who were still alive when the study ended, 47 were contacted by phone to determine their living arrangements. Overall, 31 (65%) were at home, 11 (23%) were in skilled nursing facilities, four (8%) were at assisted living centers, and one (2%) was in a rehabilitation center.
"The most significant finding of this study is that severely injured geriatric trauma patients who survive their hospitalization have appreciable long-term survival and that a surprising number return home," Dr. Ofurum said. "This study showed that the 5-year survival is almost 20%, which is similar to that of many cancer diagnoses."
She noted that she and her coinvestigators did not apply a uniform approach to the resuscitation variable in all geriatric trauma patients; instead, they used a case-by-case approach. "There is a preselection bias for patients with the most devastating injuries, as we tend not to treat them," she said.
Dr. Ofurum acknowledged some limitations of the study, including its retrospective nature, the small sample size, and the lack of data on cause of death, comorbidities, and survivors’ functional status.
"However, in our practice, it’s been noted that about one-third of deaths that occur in geriatric trauma patients are associated with immediate withdrawal of care," she said. This makes managing complications critical in this patient group. "When patients have complications such as renal failure, families may tend to withdraw care," she said.
With the exponential growth of the elderly population, this and similar studies are notable, said discussion leader Dr. Roxie Albrecht of the University of Oklahoma in Oklahoma City. "Studies such as this do give us a glimmer of hope that not every patient over the age of 65 has the Grim Reaper standing over them, predicting that they will either die in the hospital or never return to their prehospital living status," she said. She noted that the St. Luke’s study is consistent with other reports on elderly trauma (J. Trauma 1998;44:618-23; J. Trauma 2002;52:242-6).
Dr. Ofurum had no conflicts to disclose.