XXXX in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity.

@entity1 @entity131 @entity542 @entity772 @entity130
OBJECTIVE: The purpose of this study was to compare data obtained from a statewide data set for elderly @entity1 (age > 64 years) that presented with @entity131 with data from nonelderly @entity1 (age > 15 and < 65 years) with similar injuries. METHODS: The New York State Trauma Registry from January 1994 through December 1995, from @entity130 centers and community hospitals excluding New York City (45,982 @entity1 ), was examined. Head-injured @entity1 were identified by International Classification of Diseases, Ninth Revision diagnosis codes. A relative @entity542 severity scale (RHISS) was constructed on the basis of groups of these codes (range, 0 = none to 3 = severe). Comparisons were made with nonelderly @entity1 for mortality, Glasgow @entity772 Scale (GCS) score at admission and discharge, Injury Severity Score, New Injury Severity Score, and RHISS. Outcome was assessed by a Functional Independence Measure score in three major domains: expression, locomotion, and feeding. Data were analyzed by the chi2 test and Mann-Whitney U test, with p < 0.05 considered significant. RESULTS: There were 11,772 @entity1 with International Classification of Diseases, Ninth Revision diagnosis of @entity542 , of which 3,244 (27%) were elderly. There were more male subjects in the nonelderly population (78% male subjects) compared with the elderly population (50% @entity1 ). Mortality was 24.0% in the elderly population compared with 12.8% in the nonelderly population (risk ratio, 2.2; 95% confidence interval, 1.99-2.43). The elderly nonsurvivors were statistically older, and mortality rate increased with age. Stratified by GCS score, there was a higher percentage of nonsurvivors in the elderly population, even in the group with only moderately depressed GCS score (GCS score of 13-15; risk ratio, 7.8; 95% confidence interval, 6.1-9.9 for elderly vs. nonelderly). Functional outcome in all three domains was significantly worse in the elderly survivors compared with the nonelderly survivors. CONCLUSION: Elderly @entity131 @entity1 have a worse mortality and functional outcome than nonelderly @entity1 who present with @entity542 even though their @entity542 and overall injuries are seemingly less severe.
