The outcome following major trauma in the elderly. Predictors of survival

Objectives: To assess the reliability of the predicted probability of survi val calculated using TRISS methodology by the UK Trauma Network for elderly patients. Method: Analysis of 100 consecutive trauma patients 65 years and over: pros pectively entered into the UK Trauma Network database from a single centre. The probability of survival (P-s) was calculated from the UK Trauma databa se and retrospectively related to survival, premorbid medical condition and mobility. Results: Of 100 patients. 16 died and 84 survived. Eleven of the 16 who die d and 12 of the survivors had pre-existing medical disease (ASA grade III-V ) and social dependency suggesting a poor outcome, these factors being sign ificantly associated with mortality (P < 0.005). The mean P-s for the 11 wi th severe medical disease who died was 0.85 (+/-0.07) with a mean age 85 +/ -3.5). The remaining five patients who died suffered high energy injuries, had a mean age of 70 (+/-4.8) and a low probability of survival (P-s 0.40 /- 0.24). The median pre-injury mobility score was 8 in patients who surviv ed and 4.5 in those who died. Mobility score <5 was associated with an incr eased mortality following admission from Trauma (P < 0.05) Conclusions: There is a significant association between severe preexisting medical disease (ASA III-V) and death during admission for trauma. The P-s score is unrealistically high in this group of patients. A simple mobility score correlates well with outcome in this group. (C) 1999 Elsevier Science Ltd. All rights reserved.