Age-related mortality in blunt traumatic hemorrhagic shock: the killers and the life savers

• Published in: The Journal of surgical research 2017-06, Vol.213, p.199-206
• Main Authors: Hwabejire, John O., MD, MPH, Nembhard, Christine E., MD, Oyetunji, Tolulope A., MD, MPH, Seyoum, Theodros, MD, Pitan, Olumayoma, MD, Siram, Suryanarayana M., MD, Cornwell, Edward E., MD, Greene, Wendy R., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Age Factors; Aged; Aged, 80 and over; Blunt trauma; Elderly; Female; Health Status Indicators; Hemorrhagic shock; Humans; Male; Middle Aged; Mortality; Multivariate Analysis; Prognosis; Retrospective Studies; Risk Factors; Shock, Hemorrhagic - mortality; Shock, Traumatic - mortality; Surgery; Wounds, Nonpenetrating - mortality; Young Adult
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2015.04.056

Abstract Background There are sparse data on the association between age and mortality in hemorrhagic shock (HS). We examined this association in this study. Materials and methods The Glue Grant database was analyzed. Patients aged ≥16 y with blunt traumatic HS were stratified into eight age groups (16–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84, and ≥85 y) to identify the mortality inflection point. Subsequently, patients were restratified into young age (16–44 y), middle age (45–64 y), and elderly (≥65 y). Multivariate analysis was used to determine predictors of mortality by group. Results A total of 1976 patients were included, with mortality of 16%. Mortality by initial age group is as follows: 16–24 (13.0%), 25–34 (11.9%), 35–44 (11.9%), 45–54 (15.6%), 55–64 (15.7%), 65–74 (20.3%), 75–84 (38.2%), and ≥85 y (51.6%), delineating 65 y as the mortality inflection point. Overall, 55% were young, 30% middle age, and 15% elderly. Predictors of mortality in the young include multiple-organ dysfunction score (MODS; odds ratio [OR]: 1.93, confidence interval [CI]: 1.62–2.30), emergency room lactate (OR: 1.14, CI: 1.02–1.27), injury severity score (OR: 1.06, CI: 1.03–1.09), and cardiac arrest (OR: 10.60, CI: 3.05–36.86). Predictors of mortality in the middle age include MODS (OR: 1.38, CI: 1.24–1.53), cardiac arrest (OR: 12.24, CI: 5.38–27.81), craniotomy (OR: 5.62, CI: 1.93–16.37), and thoracotomy (OR: 2.76, CI: 1.28–5.98). In the elderly, predictors of mortality were age (OR: 1.07, CI: 1.02–1.13), MODS (OR: 1.47, CI: 1.26–1.72), laparotomy (OR: 2.04, CI: 1.02–4.08), and cardiac arrest (OR: 11.61, CI: 4.35–30.98). Open fixation of nonfemoral fractures was protective against mortality in all age groups. Conclusions In blunt HS, mortality parallels increasing age, with the inflection point at 65 y. MODS and cardiac arrest uniformly predict mortality across all age groups. Craniotomy and thoracotomy are associated with mortality in the middle age, whereas laparotomy is associated with mortality in the elderly.