Differences in injury pattern and mortality between Hong Kong elderly and younger patients

Abstract

Background: The rapidly aging population in Hong Kong is causing an impact on our health care system. In Hong Kong, 16.5% of emergency department trauma patients are aged ≥65 years. Objective: We aim to compare factors associated with trauma and differences in trauma mortality between elderly (≥65 years) and younger adult patients (15 to 64 years) in Hong Kong. Methods: A retrospective observational study was performed using trauma registry data from the Prince of Wales Hospital, a 1200-bed acute hospital which is a regional trauma centre. Results: A total of 2172 patients (331 [15.2%] elderly and 1841 [84.8%] younger) were included. Male patients predominated in the younger adult group but not in the elderly group. Compared with younger patients, elderly patients had more low falls and pedestrian-vehicle crashes and sustained injuries to the head, neck and extremities more frequently. The odds ratio (OR) for death following trauma was 5.5 in the elderly group (95% confidence interval [CI] 3.4-8.9, p<0.0001). Mortality rates increased progressively with age (p<0.0001) and were higher in the elderly at all levels of Injury Severity Score (ISS). Age ≥65 years independently predicted mortality (OR=5.7, 95% CI 3.5-9.3, p<0.0001). The elderly had a higher co-morbidity rate (58.6% vs. 14.1%; p<0.01). There was a lower proportion of trauma call activations for the elderly group (38.6% vs. 53.3%; p<0.01). Conclusion: Elderly trauma patients differ from younger adult trauma patients in injury patterns, modes of presentation of significant injuries and mortality rates. In particular, the high mortality of elderly trauma requires renewed prevention efforts and aggressive trauma care to maximise the chance of survival.