OUTCOME FROM CRITICAL CARE IN THE OLDEST-OLD TRAUMA PATIENTS

This study evaluated the ''oldest old'' Intensive Care Unit (ICU) trau ma patients, defined as patients of age 75 and over, to determine the relationships between age, injury magnitude, physiologic severity of i llness, and outcome in this group, compared with younger trauma patien ts. Of 1,039 consecutive Surgical ICU (SICU) patients with complete da ta, 45 were in the Oldest group, 54 were in the Elderly group (ages 65 to 74), and 940 were in the Younger group (age < 65). Age, sex, and t ype of trauma (penetrating versus blunt) did not predict outcome. The Injury Severity Score (ISS) was significantly higher in the Oldest gro up than in the other groups (p = 0.0005), but the Trauma Score was the same for all groups. The proportion of Oldest group patients with ISS greater than or equal to 20 was significantly higher than for Elderly and Younger group patients (p = 0.0002 and p < 0.00005, respectively) . The Simplified Acute Physiology Score (SAPS) on the first SICU day w as the best outcome predictor for all age groups, along with maximum S APS during the SICU stay (p < 0.00005 for both). When patients were st ratified by ISS, there was a statistically significant difference in d ay 1 SAPS among age groups for most ISS categories, with higher SAPS a ssociated with advancing age. The oldest old fare worse with trauma be cause their injury is more severe (higher ISS) and because their physi ologic response to a given level of injury is exaggerated (higher SAPS ). However, once the oldest old are stratified by SAPS, their outcome parallels that of their younger trauma cohorts. This study indicates t hat specific treatment protocols for the oldest old trauma patients ar e indicated, Once these patients reach the SICU, decisions regarding o utcome should be based on severity of illness rather than age, trauma type, or injury severity.