आघात एवं उपचार जर्नल

Road Traffic Injuries and their Outcome in the Elderly Patients 60 years and above. Does Age make a Difference?

Abstract

Malik AM, Dal NA and Talpur KAH

Objective: To investigate the injury pattern, management and outcome of road traffic injuries in the elderly patients (60 years and above) involved in motor vehicle accidents and to compare factors associated with trauma and differences in trauma mortality between elderly and younger adult patients.

Methods: This is a retrospective descriptive study conducted at a teaching hospital during Jun 2002 to Jan 2010, studying the differing pattern, and management of road traffic injuries in patients aged 60 years and above, designated as Group-A, and those below 60 years of age, designated as Group –B, regardless of gender of the patients.

All the patients were referred through casualty and were assessed clinically followed by relevant investigations. Patients who sustained minor injuries were discharged after necessary treatment while those with serious injuries requiring intervention were admitted and managed accordingly. Patients having purely orthopaedic problems like isolated fractures or spine injuries were also excluded from the study. Treatment was instituted according to the severity of the trauma ranging from conservative treatment to laparotomy and chest intubation. The variables studied included demographics of both groups of patients, pattern of injuries sustained in both groups, trauma indices ISS and GCS, mechanism of injury, major injuries sustained, treatment instituted, mean number of hospital days, and morbidity and mortality.

Details of individual patients were recorded on a proforma and data analyzed statistically on SPSS version 17.

Results: A total 300 patients (Group-A n=149[49.66%] versus Group-B n=151[50.33%]) admitted and intervened were included in the study. Male patients predominated both the groups (Group-A. [Mean age 66.91, Std 6.859, Males n=115, Females n= 34] vs Group-B [Mean age 35.52, Std 13.814, Males n= 140, Females n= 11]). The group-A patients had significantly higher proportion of co-morbidities (p<0.001) compared to group-B patients (64.42% versus 18.66%). The mortality rises progressively with age and is almost twice as high as in younger population at all levels of severity of trauma. Incidence of chest injuries with rib fractures was more common in elderly victims (P<0.001) compared to the younger patients (40.26%) versus (12.58%). The overall in hospital mortality in Group-A patients was 14.76% compared to (4.63) in group-B for an almost comparable severity of injuries sustained.

Conclusion: The incidence of road traffic accidents is on the rise in the elderly. The elderly patients have a different pattern of road traffic injuries and they respond poorly to the sustained injuries despite low ISS compared to the younger patients.