Predictors of 12‐Month Mortality for Older Adults With Trauma: A Study of Patients Aged 65 and Older Admitted to a Major Trauma Service
Elizabeth Lockie, Saskia‐Aisha Marguccio, Kellie Gumm, Katherine Martin, Yianni Roupas, Rachel Aitken, Wen Kwang Lim, David J. Read, Katherine GregorevicABSTRACT
Background
Older adults with trauma often have a complex interplay of frailty, multimorbidity and injuries intersecting to impact outcomes. This study aimed to explore the association between frailty, age and injury severity score with in‐hospital mortality, 12‐month mortality for people who survive hospitalisation and 12‐month all‐cause mortality in people aged 65 and older admitted following trauma.
Methods
The study was undertaken at a level one trauma centre and included all people aged 65 years and older admitted following trauma. The primary outcomes were in‐hospital mortality and 12‐month all‐cause mortality. Covariates included age, sex, frailty, mechanism of injury and injury severity score (ISS). Regression analysis was conducted to explore the factors associated with mortality.
Results
1381 patients were included, with median age of 79 years (IQR 73–87). Low fall was the most common mechanism (63.9%), and 55.1% of patients were frail (CFS ≥ 4), while 61.2% were minor trauma. 244 (17.5%) patients had died by 12 months post admission, with 101 of those deaths occurring prior to discharge. Frailty was associated with both in‐hospital and 12‐month all‐cause mortality, while a higher ISS was only associated with in‐hospital mortality. Multivariate analysis for in‐hospital mortality showed CFS and ISS were significant factors, and the ISS group had higher odds ratio (OR 2.61, 95% confidence interval CI 2.07–3.33, p < 0.0010). For 12‐month all‐cause mortality, multivariable regression showed age, CFS and low fall were significant.
Conclusions
Even for older adults who initially survive a traumatic injury, mortality remains high within the next twelve months, particularly for those who are also frail. This has important implications for care planning for older adults with trauma.