单中心老年创伤患者流行病学特点及意义

Epidemiological profile and significance of single-center senior trauma patients

目的探讨单中心老年创伤患者流行病学变化特点，为临床救治提供参考。方法筛选2007年1月-2014年12月收治的1646例老年创伤患者（年龄≥65岁），其中男649例，女997例；年龄65～110岁，平均76．7岁。分析患者性别、年龄、致伤原因、致伤部位、损伤严重度评分（ISS）、病死率、死亡原因、伴发病、住院时间、住院费用等变化。比较引入损害控制技术和建立“急救绿色通道”前（2007—2009年组）和后（2010—2014年组）伤情变化及死亡组与生存组患者的特点。结果老年创伤患者数量（t=7．31，P〈0．01）及其在总体创伤患者中所占比例（t=6．29，P〈0．01）均逐年上升，平均年龄逐年增加（t=3．11，P〈0．05），伴发病所得查尔森基础疾病权重指数（WIC）逐年增大（t=6．45，P〈0．01），病死率逐年下降（t=-4．27，P〈0．01），而平均ISS和ISS≥16分所占当年的比例均无明显变化（P〉0．05）。跌倒伤是首位致伤原因，且逐年增加（t=2．83，P〈0．05）。2010—2014年组平均ISS（t=2．13，P〈0．05）和ISS≥16分所占比例（χ^2=3．92，P〈0．05）均高于2007—2009年组，但其病死率却明显低于2007—2009年组（X^2=4．33，P〈0．05）。与非死亡组比较，死亡组患者年龄更大、损伤严重程度更重、伴随疾病情况也更严重，交通伤发生率更高（P均〈0．05）。结论随着创伤救治技术的改进和救治策略的完善，老年创伤患者病死率呈下降趋势。老年创伤患者的伴发病和致伤原因提示，应重点加强对老年患者创伤的预防。

Objective To analyze the epidemiological characteristics of elderly trauma patients in a single center. Methods A total of 1, 646 elderly inpatients （ age ≥ 65 years ） admitted from January 2007 to December 2014 were chosen. There were 649 men and 997 women, aged 65-110 years （mean, 76. 7 years）. Epidemiological changes were studied including gender, age, mechanisms of injury, sites of injury, injury severity score （ ISS ） , mortality, causes of death, pre-existing medical conditions, hospital length of stay, and medical expense. According to the application of damage control technology and the establishment of emergency green channel, the patients were divided into 2007-2009 year group and 2010-2014 year group for analyzing reasons of the changes, while the different characteristics between death and non-death patients were analyzed. Results Elderly trauma patients presented annual increases in quantity （ t = 7.31, P 〈 0.01 ） and proportion from the trauma population （t = 6.29, P 〈 0.01 ）. There was an annual increasing in patients＇ mean age （t = 3.11, P 〈 0.05 ） and Charlson＇s weighted index of comorbidities （WIC） for the pre-existing medical conditions （ t = 6.45, P 〈 0. 01 ） , while decreased mortality （ t = -4.27, P 〈 0.01 ） and no obvious variations in mean ISS and proportion of ISS ≥16 （P 〉 0. 05）. Fall injury was the leading cause of injury and increased showed annually （t =2. 83, P 〈0.05）. Mean ISS （t =2.13, P 〈0. 05） and proportion of ISS≥16 （X^2 =3.92, P 〈0.05） were higher in 2007-2009 year group than in 2010-2014 year group. Besides the mortality lowered in 2007-2009 year group compared to that in 2010-2014 year group （X^2 = 4.33,P 〈 0. 05）. In contrast to survivors, nonsurvivors were older, had more severe injury, sustained more severe associated conditions and experienced high incidence of traffic crashes （ P 〈 0.05 ）. Conclusions With the improved trauma care levels and protocols, mortality rate for the elderly trauma patients has been lowered. In consideration of the associated conditions and injury causes, the focus should be on strengthening trauma prevention in the elderly.