MAJOR TRAUMA OUTCOMES IN THE ELDERLY

Objectives: To study mortality and functional outcome in elderly patie nts suffering major trauma and to assess whether age affects prognosis . Design and setting: Retrospective identification of patients from th e Royal North Shore Hospital, a level three trauma service and teachin g hospital of the University of Sydney. The patients were followed up for an average of three years after admission. Patients: One hundred a nd eighteen patients aged over 60 years, with injury severity scores o ver 15, admitted consecutively between May 1988 and July 1990. To dete rmine the effects of age on outcome, patients were divided into two gr oups: those aged 61-70 years (67 patients) and over 70 years (51 patie nts). Main outcome measures: Death in hospital, late death after disch arge, change in preinjury v. current accommodation and current functio nal ability, measured with the Barthel activities of daily living inde x. Results: Thirty-six of the 118 patients died in hospital. Eighty-on e of the remaining 82 patients were followed up. Twenty-five of these patients died during the study period: three in the 61-70 years age gr oup, and 22 in the over 70 years age group (P<0.0001). Among the long term survivors, 43 of 53 continued to live independently, and 41 of 54 scored maximum points in activities of daily living assessment. Only seven people required nursing home care. Conclusions: Age is an import ant factor in survival after major trauma, but those that do survive g enerally return to full activity and independence. Aggressive treatmen t for elderly trauma victims is warranted.