Vascular Trauma

Vascular Trauma in Geriatric Patients: A National Trauma Databank Review

Konstantinidis A, Inaba K, Dubose J, et al (Univ of Southern California, Los Angeles; Univ of Maryland Med Ctr, Baltimore) J Trauma 71:909–916, 2011^§

Abstract

Background

The epidemiology of vascular injuries in the geriatric patient population has not been described. The purpose of this study was to examine nationwide data on vascular injuries in the geriatric patients and to compare this with the nongeriatric adult patients with respect to the incidence, injury mechanisms, and outcomes.

Methods

Geriatric patients aged 65 or older with at least one traumatic vascular injury were compared with an adult cohort aged 16 years to 64 years with a vascular injury using the National Trauma Databank version 7.0.

Results

During the study period, 29,736 (1.6%) patients with a vascular injury were identified. Of those, geriatric patients accounted for 7.6% (2,268) and the nongeriatric adult patients accounted for 83.1% (n = 24,703). Compared with the nongeriatric adult patients, the geriatric vascular patients had a significantly higher Injury Severity Score (26.6 ± 17.0 vs. 21.3 ± 16.7; p < 0.001) and less frequently sustained penetrating injuries (16.1% vs. 54.1%; p < 0.001). The most commonly injured vessels in the elderly were vessels of the chest (n = 637, 40.2%), including the thoracic aorta and innominate and subclavian vessels. The overall incidence of thoracic aorta injuries was significantly higher in geriatric patients (33.0% vs. 13.9%; p < 0.001) and increased linearly with progressing age. After adjusting for confounding factors, geriatric patients demonstrated a fourfold increase in mortality following vascular injuries (adjusted odds ratio, 3.9; 95% confidence interval, 3.32–4.58; p < 0.001).

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