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Assessment of mortality in older trauma patients sustaining injuries from falls or motor vehicle collisions treated in regional level I trauma centers.
Ann Surg. 2009 Mar;249(3):488-95
Publication Type
John S Sampalis
Robin Nathanson
Julie Vaillancourt
Andreas Nikolis
Moishe Liberman
John Angelopoulos
Nickolaos Krassakopoulos
Nadia Longo
Eliofotisti Psaradellis
Author Affiliation
Department of Surgery, Surgical Research, McGill University, Montreal, Quebec, Canada.
Ann Surg. 2009 Mar;249(3):488-95
Publication Type
Accidental Falls - statistics & numerical data
Accidents, Traffic - statistics & numerical data
Age Factors
Aged, 80 and over
Cohort Studies
Quebec - epidemiology
Retrospective Studies
Trauma Centers - statistics & numerical data
Wounds and Injuries - mortality
To compare mortality in elderly trauma patients sustaining fall or motor vehicle collision (MVC) related injuries and who are subsequently treated at regional Level I (tertiary) trauma centers.
An increase in the mean age of the Canadian population is leading to a higher proportion of older patients injured in falls who are subsequently treated at Level 1 trauma centers in Quebec. The Level 1 centers were designed to treat younger patients injured in MVCs and violent acts. As a result, discordance may exist between the type of care supplied at these centers and the increased demand for care tailored to older trauma patients.
A retrospective cohort study comprised of 4,717 patients over the age of 65; 606 (12.8%) injured in MVCs and 4,111 (87.2%) in falls. The mean (SD) age was 79.6 (8.0) years and 67.9% were female. The mean (SD) Injury Severity Score (ISS) was 10.8 (7.4). Data were obtained from the Quebec Trauma Registry (QTR) for patients treated at 3 Level I trauma centers in the province of Quebec, Canada. The primary outcome measure in this study was mortality.
Being injured in a fall was a strong predictor for mortality, with an odds ratio of 5.11 (95% C.I. = 1.84-14.17, P = 0.002). Additionally, the adjusted mortality rate was 25.3% among fall victims, versus 7.8% for MVC patients. Female gender, older age, higher ISS and an increasing number of injuries were all associated with heightened mortality. In contrast, the number of body regions injured, experiencing complications, sustaining a hip fracture, the Revised Trauma Score, the Prehospital Index and the Charlson (comorbidity) Index had no association with mortality in the Level I centers.
Elderly patients sustaining fall-related injuries and treated at Level I trauma centers are at risk for excess mortality when compared with those injured in MVCs. Effective and efficient methods for treating this population must be determined.
PubMed ID
19247039 View in PubMed
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