The outcome and follow-up of trauma in elderly intensive care unit patients

Introduction

Geriatric trauma is steadily expanded, mainly as a result of increased vehicle accidents. The outcome of geriatric trauma is considered significantly worse in comparison with that of younger people. Although the cutoff of age above which a patient is grouped as a geriatric one on a pathophysiological basis is not clear, patients above 65 years old are generally accepted as belonging to the geriatric group. In Greece, trauma is a very common disease and elderly patients are affected in a continuously increased manner. In our retrospective study we have recorded the incidence, ICU, hospital and home mortality as well as an approach to the quality of life of geriatric trauma critically ill patients after a period up to 5 years after ICU discharge.

Methods

All multi-trauma patients over 65 years of age admitted in a seven-bed university ICU during the period 2000–2004 were recorded retrospectively. The collected data include: ICU mortality, hospital mortality, home mortality, and gross estimation of quality of life, 1–58 months after ICU discharge. For this estimation we used a simplified questionnaire on the basis of that published by Fernandez and colleagues [1], and the modified criteria are presented in Table 1. Each of them had the answer 'yes = 1 or no = 0' and the range can be between 0 and 10. The information for the outcome of patients outside the hospital was taken by telephone communication of ICU physicians with the patients or their relatives.

Table 1 Table 1

Results

During a nearly 5-year period (lasting from 2 March 2000 to 14 November 2004) 229 multi-trauma patients were admitted to our seven-bed university ICU. Seventy of them (31%) were above 65 years old (mean ± standard error, 76.5 ± 8). Thirty-seven (53%) (77 ± 9 years old) died inside the ICU. The remaining 33 (76.5 ± 6.6 years, range 66–89) were discharged from the ICU and treated on different medical departments (surgical, neurosurgical, etc.). Seven of them died during the hospital stay outside the ICU. The outcome 1–58 months after ICU discharge was recorded after telephone communication in 15 from the remaining 26 patients. From those 15 patients, three died at home and 12 (17% of the total 70 patients) are alive 32.6 ± 9.6 months after discharge. Nearly all the alive stay at home and they have an excellent quality of life on the basis of our simplified scale (with the exception of one patient the mean value is 9.3 ± 1).

Conclusions

Geriatric trauma has a poor prognosis with high ICU mortality. In our study the ICU mortality of geriatric multi-trauma patients was in accordance with the literature [2]. The follow-up of these patients is difficult, at least on a retrospective basis, and in our study we have obtained data from about two-thirds of the whole number of hospital discharged patients. Surprisingly, the quality of life in this restricted part of geriatric patients can be characterized as very good or excellent.