Six month outcome of extremely old (≥95 years) trauma patients

SIR—Trauma in the elderly is an issue of escalating importance in health care. The proportion of the 6 billion individuals born in the twentieth century surviving to age 65 in the twenty-first century will continue to increase because of improvements in public health, medicine and economic conditions in developed as well as emerging developing countries. In extremely old (≥95 years) trauma patients, clinical management must strike a balance between potentially detrimental aggressive treatment and an inappropriately conservative approach [1–3]. The cost of trauma care for elderly patients will continue to increase due to the proportional increase in the ageing population. The National Trauma Database in the US has stated that elderly trauma patients account for 25% of all trauma and use about onethird of the total trauma health care resources [4]. Although trauma in elderly patients has been studied previously, there are no such reports detailing outcome in patients aged 95 years or older [5, 6]. Our emergency department in Bern, Switzerland, is a level 1 trauma referral centre serving a population of about 1.5 million people. All cases were collected from a computer database using defined key words (trauma, age ≥95 years). A total of 57,248 case histories of patients presenting to the department of emergency medicine between January 2002 and December 2003 were reviewed using the ‘Qualicare’ database. This yielded 50 consecutive patients meeting the entry criteria of incurring a trauma injury and being ≥95 years. Their six-months outcome after the injury was assessed by phoning the patients themselves and by contacting their relatives or general practitioners. Patients were questioned about their general health and their ability to undertake activities of daily living compared with their premorbid state, including dressing, self-hygiene and preparing meals. Fifty consecutive patients (42 females) 95 years presented with trauma during the study period. Their mean age was 97 years (range 95–103). The presence of pre-existing cardiovascular disease was noted in 64% and diabetes mellitus in 28% (Table 1). Forty-two (84%) of injuries occurred indoors, the remainder outdoors. Twenty were treated on an out-patient basis, eight of them had isolated fractures of the distal arm (e.g., Colles fracture). All trauma was blunt and consisted largely of lower limb fractures (n = 32, 64%). Among admitted patients, the median hospital stay was 6 days (range 1–27 days). In n = 22 (44%) patients, surgery was necessary. No intraoperative death had been noted. Four patients died due to pre-existing co-morbidity between 8 and 16 days after hospitalisation. Two patients died within 24 h of admission due to severe head injury. All 44 patients who were discharged after treatment returned to their pre-morbid home environment. No discharged patient died within the first 6 months after trauma (Table 1). Our results could imply that once the elderly have survived the initial injury, their prognosis for a good outcome is similar to that of younger patients concerning their functional status. Comparisons between the studies of trauma can be difficult, because of differences in the severity of the injuries observed. Ours is a sizeable patient cohort of extremely old trauma patients, with injuries ranging from minor Colles fracture, managed on an out-patient basis, to fractured neck of femur, which is associated with significant morbidity. Despite this, 88% of our patients had not only survived but also recovered to their pre-injury standard of living. In summary, this retrospective review of over 57,000 emergency department attendances identified 50 patients 95 years or older presenting with trauma. Notwithstanding their advanced years and pre-existing co-morbidity, 88% had resumed their pre-injury state at 6 months, suggesting that extremely old trauma patients merit consideration of definitive treatment as for younger patients.