Zietlow et al identified a number of risk factors for death in an elderly patient suffering multisystem trauma. These can help identify patients who may benefit from more aggressive management. The authors are from the Mayo Clinic.
Patient selection:
(1) age >= 65 years of age
(2) injury severity score (ISS) >= 10
(3) presence of multisystem injury
Most common causes of the multisystem injury:
(1) falls
(2) motor vehicle accidents
Risk factors for mortality:
(1) history of previous myocardial infarction
(2) chronic renal insufficiency
(3) need for ventilatory and/or inotropic support
(4) systolic blood pressure <= 90 mm Hg on admission
(5) heart rate <= 60 beats per minute on admission
(6) severe closed head injury with Glasgow Coma Scale (GCS) <= 8
Mortality was 23% in the study population and was high in those the closed head injury. However, most of the patients who survived were able to return home and remain functionally independent.
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