MULTIPLE TRAUMA IN PATIENTS OF 65 AND OVER INJURY PATTERNS - FACTORS INFLUENCING OUTCOME THE IMPORTANCE OF AN AGGRESSIVE CARE

In a first study of 416 polytrauma patients, 49 were aged 65 years or older. These ''old patients'' (mean age 72. 1) were compared with the remaining 367 ''young patients'' (mean age 31.3). In a second study co ncerning 126 polytrauma patients of 65 and over, the survivors and non survivors were profiled and compared. The typical injured old patient was a pedestrian hit by a car or a motorbike or someone who had simpl y fallen at home. Despite the fact that the mean Injury Severity Score (ISS) was significantly lower in the old patients' groups (33.2 versu s 42.1-degrees) (p < 0.0001) the mortality rate was higher (18% versus 7.6%) (p < 0.05). In old trauma victims multiple system organ failure (MSOF) was responsible for the fatal outcome in 48% of the cases and in 71% of the deaths more than 7 days after trauma. Seventy eight perc ent of the surviving old patients still living at home pre-injury were able to go back to their normal surroundings. In the old patients gro ups there was no significant difference in age nor in ISS nor in pre-e xisting diseases between survivors and non-survivors. On the other han d the Glasgow Coma Scale (GCS) was of important prognostic value, as w ell as to survival as to functional recovery (p < 0.001). Also the nee d for early intubation and continued ventilation were predictive of su rvival (p < 0.001). Nevertheless this need for respiratory assistance was not an indication for withdrawing support as also 9% of the surviv ors required endotracheal intubation for 5 days or longer. As the fina l outcome in the elderly is no worse after polytrauma than after other important emergency procedures, an agressive geriatric trauma care is justifed...