MORTALITY FACTORS IN GERIATRIC BLUNT TRAUMA PATIENTS

Objective: To examine various clinical factors for their ability to pr edict mortality in geriatric patients following blunt trauma. Design: In this retrospective study, trauma registries and medical records fro m three trauma centers were reviewed for patients 65 years and older w ho had sustained blunt trauma. The following variables were extracted and examined independently and in combination for their ability to pre dict death: age, gender, mechanism of injury, admission blood pressure , and Glasgow Coma Scale score, respiratory status, Trauma Score, Revi sed Trauma Score, and Injury Severity Score. Setting: Three urban trau ma centers. Patients: Geriatric trauma patients entering three trauma centers (Stanford [Calif] University Hospital, Vanderbilt University M edical Center, Nashville, Tenn, and Maryland Institute for Emergency M edical Services Systems,Baltimore) following blunt trauma during a 7-y ear period (1982 to 1989). Results: The Injury Severity Score was the single variable that correlated most significantly with mortality. Mor tality rates were higher for men than for women and were significantly higher in patients 75 years and older. Admission variables associated with the highest relative risks of death included a Trauma Score less than 7; hypotension (systolic blood pressure, <90 mm Hg); hypoventila tion (respiratory rate, <10 breaths per minute); or a Glasgow Coma Sca le score equal to 3. Conclusions: Admission variables in geriatric tra uma patients can be used to predict outcome and may also be useful in making decisions about triage, quality assurance, and use of intensive care unit beds.