Faculty Collaboration Database

Penetrating torso injuries in older adults: increased mortality likely due to "failure to rescue". Eur J Trauma Emerg Surg 2015 Dec;41(6):657-63

Date

06/04/2015

Pubmed ID

26038012

DOI

10.1007/s00068-014-0491-7

Scopus ID

2-s2.0-84949086173 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

PURPOSE: Approximately 8 % of injuries in the elderly are from penetrating mechanisms. The natural history of potentially survivable penetrating torso wounds in the elderly is not well studied. Older adults with penetrating injuries to the torso may have worse outcomes than matched, younger patients due to a failure to rescue after complications.

METHODS: A retrospective chart review of all patients ≥55 (older) with a penetrating injury (GSW or SW) to the torso over 20 years was performed. All patients with a maximum AIS chest or abdomen >1 and <6 were included. A matched cohort (mechanism, AIS chest and abdomen, ISS and sex) of patients between the ages of 20-40 years (young) was created (3 young, 1 older). Differences in hemodynamics, complications, length of stay and mortality were analyzed.

RESULTS: 105 older met inclusion criteria were compared to 315 young patients. Hemodynamic status was similar between the groups. Older patients required ICU care more often than younger patients, p < 0.05. Older patients required longer ICU stays, p < 0.001 and longer hospitalizations, p = 0.0012. More older patients (41.0 %) suffered post-injury complications compared to the young (26.4 %), p = 0.005. Older patients who suffered a complication had a higher mortality (30.2 %) than the young after a complication (10.8 %), p = 0.007.

CONCLUSIONS: While uncommon, penetrating injuries to older adults are associated with higher rates of post-injury complications and increased mortality. This may represent a "failure to rescue" and represent an opportunity for improved post-injury care in older adults who suffer potentially survivable penetrating torso injuries.

Author List

Allen SR, Scantling DR, Delgado MK, Mancini J, Holena DN, Kim P, Pascual JL, Reilly P

Author

Daniel N. Holena MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Abdominal Injuries
Aged
Case-Control Studies
Critical Care
Failure to Rescue, Health Care
Female
Hemodynamics
Humans
Length of Stay
Male
Middle Aged
Pennsylvania
Prognosis
Risk Factors
Thoracic Injuries
Wounds, Penetrating