Multiple trauma in patients of 65 and over. Injury patterns. Factors influencing outcome. The importance of an aggressive care.

In a first study of 416 polytrauma patients, 49 were aged 65 years or older. These "old patients" (mean age 72.1) were compared with the remaining 367 "young patients" (mean age 31.3). In a second study concerning 126 polytrauma patients of 65 and over, the survivors and non survivors were profiled and compared. The typical injured old patient was a pedestrian hit by a car or a motorbike or someone who had simply fallen at home. Despite the fact that the mean Injury Severity Score (ISS) was significantly lower in the old patients' groups (33.2 versus 42.1 degrees) (p < 0.0001) the mortality rate was higher (18% versus 7.6%) (p < 0.05). In old trauma victims multiple system organ failure (MSOF) was responsible for the fatal outcome in 48% of the cases and in 71% of the deaths more than 7 days after trauma. Seventy eight percent of the surviving old patients still living at home pre-injury were able to go back to their normal surroundings. In the old patients groups there was no significant difference in age nor in ISS nor in pre-existing diseases between survivors and non-survivors. On the other hand the Glasgow Coma Scale (GCS) was of important prognostic value, as well as to survival as to functional recovery (p < 0.001). Also the need for early intubation and continued ventilation were predictive of survival (p < 0.001). Nevertheless this need for respiratory assistance was not an indication for withdrawing support as also 9% of the survivors required endotracheal intubation for 5 days or longer.(ABSTRACT TRUNCATED AT 250 WORDS)