Predictors of mortality in geriatric trauma patients: A systematic review and meta-analysis

Ammar Hashmi, Irada Ibrahim-Zada, Peter M Rhee, Hassan Aziz, Mindy J Fain, Randall S Friese, Bellal A Joseph

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

BACKGROUND: The rate of mortality and factors predicting worst outcomes in the geriatric population presenting with trauma are not well established. This study aimed to examine mortality rates in severe and extremely severe injured individuals 65 years or older and to identify the predictors of mortality based on available evidence in the literature. METHODS: We performed a systematic literature search on studies reporting mortality and severity of injury in geriatric trauma patients using MEDLINE, PubMed, and Web of Science. RESULTS: An overall mortality rate of 14.8% (95% confidence interval [CI], 9.8-21.7%) in geriatric trauma patients was observed. Increasing age and severity of injury were found to be associated with higher mortality rates in this patient population. Combined odds of dying in those older than 74 years was 1.67 (95% CI, 1.34-2.08) compared with the elderly population aged 65 years to 74 years. However, the odds of dying in patients 85 years and older compared with those of 75 years to 84 years was not different (odds ratio, 1.23; 95% CI, 0.99-1.52). A pooled mortality rate of 26.5% (95% CI, 23.4-29.8%) was observed in the severely injured (Injury Severity Score [ISS] ≥ 16) geriatric trauma patients. Compared with those with mild or moderate injury, the odds of mortality in severe and extremely severe injuries were 9.5 (95% CI, 6.3-14.5) and 52.3 (95% CI, 32.0-85.5; p ≤ 0.0001), respectively. Low systolic blood pressure had a pooled odds of 2.16 (95% CI, 1.59-2.94) for mortality. CONCLUSION: Overall mortality rate among the geriatric population presenting with trauma is higher than among the adult trauma population. Patients older than 74 years experiencing traumatic injuries are at a higher risk for mortality than the younger geriatric group. However, the trauma-related mortality sustains the same rate after the age of 74 years without any further increase. Moreover, severe and extremely severe injuries and low systolic blood pressure at the presentation among geriatric trauma patients are significant risk factors for mortality.

Original languageEnglish (US)
Pages (from-to)894-901
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number3
DOIs
StatePublished - Mar 2014

Fingerprint

Geriatrics
Meta-Analysis
Mortality
Wounds and Injuries
Confidence Intervals
Population
Hypotension
Blood Pressure
Injury Severity Score
PubMed
MEDLINE
Odds Ratio

Keywords

  • Age and mortality
  • Geriatric trauma
  • Injury severity score
  • Predictors of mortality
  • Trauma mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Predictors of mortality in geriatric trauma patients : A systematic review and meta-analysis. / Hashmi, Ammar; Ibrahim-Zada, Irada; Rhee, Peter M; Aziz, Hassan; Fain, Mindy J; Friese, Randall S; Joseph, Bellal A.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 3, 03.2014, p. 894-901.

Research output: Contribution to journalArticle

@article{5583a1d23d8f4604b0ac659fa208438f,
title = "Predictors of mortality in geriatric trauma patients: A systematic review and meta-analysis",
abstract = "BACKGROUND: The rate of mortality and factors predicting worst outcomes in the geriatric population presenting with trauma are not well established. This study aimed to examine mortality rates in severe and extremely severe injured individuals 65 years or older and to identify the predictors of mortality based on available evidence in the literature. METHODS: We performed a systematic literature search on studies reporting mortality and severity of injury in geriatric trauma patients using MEDLINE, PubMed, and Web of Science. RESULTS: An overall mortality rate of 14.8{\%} (95{\%} confidence interval [CI], 9.8-21.7{\%}) in geriatric trauma patients was observed. Increasing age and severity of injury were found to be associated with higher mortality rates in this patient population. Combined odds of dying in those older than 74 years was 1.67 (95{\%} CI, 1.34-2.08) compared with the elderly population aged 65 years to 74 years. However, the odds of dying in patients 85 years and older compared with those of 75 years to 84 years was not different (odds ratio, 1.23; 95{\%} CI, 0.99-1.52). A pooled mortality rate of 26.5{\%} (95{\%} CI, 23.4-29.8{\%}) was observed in the severely injured (Injury Severity Score [ISS] ≥ 16) geriatric trauma patients. Compared with those with mild or moderate injury, the odds of mortality in severe and extremely severe injuries were 9.5 (95{\%} CI, 6.3-14.5) and 52.3 (95{\%} CI, 32.0-85.5; p ≤ 0.0001), respectively. Low systolic blood pressure had a pooled odds of 2.16 (95{\%} CI, 1.59-2.94) for mortality. CONCLUSION: Overall mortality rate among the geriatric population presenting with trauma is higher than among the adult trauma population. Patients older than 74 years experiencing traumatic injuries are at a higher risk for mortality than the younger geriatric group. However, the trauma-related mortality sustains the same rate after the age of 74 years without any further increase. Moreover, severe and extremely severe injuries and low systolic blood pressure at the presentation among geriatric trauma patients are significant risk factors for mortality.",
keywords = "Age and mortality, Geriatric trauma, Injury severity score, Predictors of mortality, Trauma mortality",
author = "Ammar Hashmi and Irada Ibrahim-Zada and Rhee, {Peter M} and Hassan Aziz and Fain, {Mindy J} and Friese, {Randall S} and Joseph, {Bellal A}",
year = "2014",
month = "3",
doi = "10.1097/TA.0b013e3182ab0763",
language = "English (US)",
volume = "76",
pages = "894--901",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Predictors of mortality in geriatric trauma patients

T2 - A systematic review and meta-analysis

AU - Hashmi, Ammar

AU - Ibrahim-Zada, Irada

AU - Rhee, Peter M

AU - Aziz, Hassan

AU - Fain, Mindy J

AU - Friese, Randall S

AU - Joseph, Bellal A

PY - 2014/3

Y1 - 2014/3

N2 - BACKGROUND: The rate of mortality and factors predicting worst outcomes in the geriatric population presenting with trauma are not well established. This study aimed to examine mortality rates in severe and extremely severe injured individuals 65 years or older and to identify the predictors of mortality based on available evidence in the literature. METHODS: We performed a systematic literature search on studies reporting mortality and severity of injury in geriatric trauma patients using MEDLINE, PubMed, and Web of Science. RESULTS: An overall mortality rate of 14.8% (95% confidence interval [CI], 9.8-21.7%) in geriatric trauma patients was observed. Increasing age and severity of injury were found to be associated with higher mortality rates in this patient population. Combined odds of dying in those older than 74 years was 1.67 (95% CI, 1.34-2.08) compared with the elderly population aged 65 years to 74 years. However, the odds of dying in patients 85 years and older compared with those of 75 years to 84 years was not different (odds ratio, 1.23; 95% CI, 0.99-1.52). A pooled mortality rate of 26.5% (95% CI, 23.4-29.8%) was observed in the severely injured (Injury Severity Score [ISS] ≥ 16) geriatric trauma patients. Compared with those with mild or moderate injury, the odds of mortality in severe and extremely severe injuries were 9.5 (95% CI, 6.3-14.5) and 52.3 (95% CI, 32.0-85.5; p ≤ 0.0001), respectively. Low systolic blood pressure had a pooled odds of 2.16 (95% CI, 1.59-2.94) for mortality. CONCLUSION: Overall mortality rate among the geriatric population presenting with trauma is higher than among the adult trauma population. Patients older than 74 years experiencing traumatic injuries are at a higher risk for mortality than the younger geriatric group. However, the trauma-related mortality sustains the same rate after the age of 74 years without any further increase. Moreover, severe and extremely severe injuries and low systolic blood pressure at the presentation among geriatric trauma patients are significant risk factors for mortality.

AB - BACKGROUND: The rate of mortality and factors predicting worst outcomes in the geriatric population presenting with trauma are not well established. This study aimed to examine mortality rates in severe and extremely severe injured individuals 65 years or older and to identify the predictors of mortality based on available evidence in the literature. METHODS: We performed a systematic literature search on studies reporting mortality and severity of injury in geriatric trauma patients using MEDLINE, PubMed, and Web of Science. RESULTS: An overall mortality rate of 14.8% (95% confidence interval [CI], 9.8-21.7%) in geriatric trauma patients was observed. Increasing age and severity of injury were found to be associated with higher mortality rates in this patient population. Combined odds of dying in those older than 74 years was 1.67 (95% CI, 1.34-2.08) compared with the elderly population aged 65 years to 74 years. However, the odds of dying in patients 85 years and older compared with those of 75 years to 84 years was not different (odds ratio, 1.23; 95% CI, 0.99-1.52). A pooled mortality rate of 26.5% (95% CI, 23.4-29.8%) was observed in the severely injured (Injury Severity Score [ISS] ≥ 16) geriatric trauma patients. Compared with those with mild or moderate injury, the odds of mortality in severe and extremely severe injuries were 9.5 (95% CI, 6.3-14.5) and 52.3 (95% CI, 32.0-85.5; p ≤ 0.0001), respectively. Low systolic blood pressure had a pooled odds of 2.16 (95% CI, 1.59-2.94) for mortality. CONCLUSION: Overall mortality rate among the geriatric population presenting with trauma is higher than among the adult trauma population. Patients older than 74 years experiencing traumatic injuries are at a higher risk for mortality than the younger geriatric group. However, the trauma-related mortality sustains the same rate after the age of 74 years without any further increase. Moreover, severe and extremely severe injuries and low systolic blood pressure at the presentation among geriatric trauma patients are significant risk factors for mortality.

KW - Age and mortality

KW - Geriatric trauma

KW - Injury severity score

KW - Predictors of mortality

KW - Trauma mortality

UR - http://www.scopus.com/inward/record.url?scp=84896717184&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896717184&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3182ab0763

DO - 10.1097/TA.0b013e3182ab0763

M3 - Article

C2 - 24553567

AN - SCOPUS:84896717184

VL - 76

SP - 894

EP - 901

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 3

ER -