Research Activities, November-December 2013
Study seeks to develop a clinical tool predicting mortality risk for severely injured older patients with complications
Patient Safety and Quality
Geriatric trauma patients experience poorer survival and greater complication rates when severely injured compared with younger patients with comparably severe injuries. In a national dataset of 285,000 hospitalized patients with moderate-to-severe traumatic injury, researchers found that nearly all infections in the post-injury hospital course were associated with at least double the risk of death for older (65 and older) versus younger (18 to 64 years old) patients. These infections ranged from pneumonia, abscess, wound infection, urinary tract infections, and aspiration pneumonia. Certain noninfectious complications also were identified with greater mortality among older patients, including failure of reduction/fixation, pressure ulcer, deep venous thrombosis, pneumothorax, pulmonary embolism, and compartment syndrome (when excessive pressures build up inside an enclosed space, usually after bleeding or swelling after an injury, which can lead to permanent injury).
Because current guidelines recommend risk stratification at the time of admission for older patients, the researchers aimed to identify the complications most associated with mortality and to develop a simple clinical risk nomogram (line chart) to predict patients at greatest risk for mortality-associated geriatric complications (MGCs). A clinical risk nomogram would allow clinicians to assess the risk of a MGC or death.
By categorizing the level of preexisting condition burden based on age, comorbidity, and sex, the researchers were able to develop a nomogram to identify risk of MGCs or death at the time of admission. They suggest that their nomogram, when validated by prospective and population-based studies, may lead to targeted interventions tailored to older patients. This study was supported by AHRQ (HS19979).
See "A simple clinical risk nomogram to predict mortality-associated geriatric complications in severely injured geriatric patients," by Lillian Min, M.D., Sigrid Burruss, M.D., Eric Morley, M.P.H., and others in the Journal of Trauma Acute Care Surgery 74, pp. 1125-1132, 2013.