High risk trauma in older adults in Hong Kong: A multicentre study

• Published in: Injury Vol. 39; no. 9; pp. 1034 - 1041
• Main Authors: Yeung, Janice H.H, Chang, Annice Ling Mui, Ho, Wendy, So, Fung Ling, Graham, Colin A, Cheng, Beatrice, Cheung, N.K, Ho, H.F, Yuen, W.K, Kam, C.W, Rainer, Timothy H
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.2008; Elsevier
• Subjects: Aetiology; Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Co-morbidity; Diseases of the osteoarticular system; Elderly; Emergency departments; Female; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Glasgow Coma Scale; Hong Kong; Hong Kong - epidemiology; Hospital Mortality; Humans; Injuries of the limb. Injuries of the spine; Injury; Injury Severity Score; Logistic Models; Major trauma; Male; Medical sciences; Middle Aged; Older adults; Orthopedics; Outcome; Retrospective Studies; Risk Factors; Trauma; Trauma Centers - statistics & numerical data; Traumas. Diseases due to physical agents; Wounds and Injuries - classification; Wounds and Injuries - epidemiology; Wounds and Injuries - etiology; Hong Kong; Asia; China; China, People's Rep., Hong Kong; British Isles, Scotland, Glasgow; Major trauma; Emergency departments; Hong Kong; Injury; Outcome; Elderly; Older adults; Trauma; Co-morbidity; Aetiology; Human; High risk; Prognosis; Epidemiology; Morbidity; Emergency department; Etiology; Adult; Anesthesia
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2008.03.017

Summary Background Trauma is the eighth leading cause of death in Hong Kong. In 2002, 18.5% of the population of Hong Kong was aged 55 years or above, which increased to 22.1% in 2006. The increasing older population in Hong Kong presents a challenge to the health care system yet there is little local data on older trauma patients. The objectives of this study are firstly to describe the epidemiology of high risk trauma in older patients in Hong Kong, and secondly to identify predictors of trauma mortality. Method Retrospective analysis of prospectively collected data from a centralised trauma database; data collected from 2002 to 2004 from four trauma centres in Hong Kong. Results Between 2002 and 2004, the four trauma centres had a total of 2,124,175 emergency department attendances of which 376,021 (17.7%) were trauma patients, and 80,827 (3.8%) were aged 55 years or older. 810 injured older patients met the inclusion criteria for this study. 380 (46.9%) patients had co-morbidity at the time of injury. Common causes of injury were falls (50.0%, 405/810) and motor vehicle crashes (33.6%, 272/810) of which (77.2%, 210/272) were pedestrians. Mortality was 24.4% (198/810) and increased with advancing age ( p < 0.0001). 53.5% (433/810) of patients had major trauma (ISS > 15). Head injury contributed to 80.3% (159/198) of deaths. 38.4% (311/810) of patients required operations. Most patients were discharged home (40.5%, 328/810) and one-third (270/810) required rehabilitation. Significant predictors of mortality included co-morbidity, injury severity score, age and decreasing Glasgow Coma Score. Conclusion Pedestrians struck by motor vehicles and falls are the principal causes of trauma in older patients in Hong Kong. Mortality increased with advancing age. The independent indicators of trauma mortality in older patients are co-morbidity, age, ISS and GCS.