AGS: Abdominal Organ Damage Deadly for Elderly

SEATTLE, May 4 -- Elderly trauma patients are at a disproportionate mortality risk from even minor abdominal organ injuries, researchers reported here.

Patients ages 80 and older were at 200% to 300% higher mortality risk from grade one and two liver and kidney injuries, found Catherine M. Glew, M.D., and James Reed III, Ph.D., of Lehigh Valley Hospital in Allentown, Pa.

One reason may be that elderly patients were less likely to be operated on than younger patients at each grade of injury, they reported at the American Geriatrics Society meeting.

The findings capsulize a fundamental conundrum facing geriatricians. "Old people are more likely to die than young people;" Dr. Glew said. "You can't get away from it."

However, "really good geriatric evaluation and treatment targeted to those frail elders with potentially survivable injuries may improve outcomes and survival," she said.

The researchers analyzed data from the National Trauma Data Bank, which includes more than two million cases from 600 U.S. trauma centers.

Among the 21,532 liver injuries in the database, 317 were in patients over age 80. Among the 9,334 kidney and 21,772 spleen injuries in the database, 149 and 393, respectively, were in patients over age 80.

Mortality was disproportionately high for elderly patients in each category. Comparing elderly versus all patients, the findings for minor grade one and two injuries were:

• 22.1% versus 9.5% for kidney injuries (P

Although the number of older patients was small in each grade of injury, "the trend was toward lack of operative intervention for these severely injured patients," Dr. Glew said.

One of the reasons may be their poorer physical condition, she added.

"Because of their pre-existing medical conditions, and relatively poor physiologic reserves, geriatric patients tend to do poorly when compared to younger cohorts with similar degrees of injury," she said.

However, the data available did not allow the researchers to determine the reason for surgical decisions or whether these decisions were appropriate.

"It was not possible to determine if any of the excess mortality and relative lack of operative intervention were due to withdrawal of care, which may be more likely in these frail elders," Dr. Glew said.