Analysis of Trauma Characteristics Between the Older and Younger Adult Patient from the Pan Asian Trauma Outcome Study Registry (PATOS)

Abstract

Objective

Asia is experiencing a demographic shift toward an aging population at an unrivaled rate. This can influence the characteristics and outcomes of trauma. We aim to examine different characteristics of older adult trauma patients compared to younger adult trauma patients and describe factors that affect the outcomes in Asian countries.

Methods

This is a retrospective, international, multicenter study of trauma across participating centers in the Pan Asian Trauma Outcome Study (PATOS) registry, which included trauma cases aged ≥18 years, brought to the emergency department (ED) by emergency medical services (EMS) from October 2015 to November 2018. Data of older adults (≥65 years) and younger adults (<65 years) were analyzed and compared. The primary outcome measure was in-hospital mortality, and secondary outcomes were disability at discharge and hospital and intensive care unit (ICU) length of stays.

Results

Of 39,804 trauma patients, 10,770 (27.1%) were older adults. Trauma occurred more among older adult women (54.7% vs 33.2%, p < 0.001). Falls were more frequent in older adults (66.3% vs 24.9%, p < 0.001) who also had higher mean Injury Severity Score (ISS) compared to the younger adult trauma patient (5.4 ± 6.78 vs 4.76 ± 8.60, p < 0.001). Older adult trauma patients had a greater incidence of poor Glasgow Outcome Scale (GOS) (13.4% vs 4.1%, p < 0.001), higher hospital mortality (1.5% vs 0.9%, p < 0.001) and longer median hospital length of stay (12.8 vs 9.8, p < 0.001). Multiple logistic regression revealed age (adjusted odds ratio [AOR] 1.06, 95%CI 1.02–1.04, p < 0.001), male sex (AOR 1.60, 95%CI 1.04–2.46, p = 0.032), head and face injuries (AOR 3.25, 95%CI 2.06–5.11, p < 0.001), abdominal and pelvic injuries (AOR 2.78, 95%CI 1.48–5.23, p = 0.002), cardiovascular (AOR 2.71, 95%CI 1.40–5.22, p = 0.003), pulmonary (AOR 3.13, 95%CI 1.30–7.53, p = 0.011) and cancer (AOR 2.03, 95%CI 1.02–4.06, p = 0.045) comorbidities, severe ISS (AOR 2.06, 95%CI 1.23–3.45, p = 0.006), and Glasgow Coma Scale (GCS) ≤8 (AOR 12.50, 95%CI 6.95–22.48, p < 0.001) were significant predictors of hospital mortality.

Conclusions

Older trauma patients in the Asian region have a higher mortality rate than their younger counterparts, with many significant predictors. These findings illustrate the different characteristics of older trauma patients and their potential to influence the outcome. Preventive measures for elderly trauma should be targeted based on these factors.

Authors and Contributions

M.Am Mokhtar was responsible for the writing of the original draft. Z.I. Azhar was responsible for the statistical analysis. S.F. Jamaluddin and D.C. Cone were responsible for conceptualizing and writing the methodology. S.D. Shin, G. E. Shaun, W.-C. Chiang, and D.N. Son were responsible for project administration and resources. K. Kajino, K.J. Song, and N.A. Norzan were responsible for the supervision of this study. M.Am Mokhtar, S.F. Jamaluddin, Z.I. Azhar, and D.C. Cone were responsible for reviewing and editing this article.

Author note

*Goh E. Shaun is also affiliated with Emergency Department, Woodlands Health, Singapore.

**Investigators are listed in Appendix A.

Acknowledgments

The authors thank the investigators and researchers from participating PATOS sites for the collaboration.

Data availability statement

Data from this study is available from Pan-Asian Trauma Outcomes Study (PATOS). Restrictions apply to the availability of these data and are not publicly available. However, data are available from the authors upon request and with the permission of PATOS. For more detailed information on PATOS, the following website is available, http://lems.re.kr/eng/patos-research/.

Disclosure statement

No potential conflict of interest was reported by the author(s).