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Don't Underestimate Upper Extremity Trauma in the Elderly
Aakash Chauhan, MD, MBA; Alan Slipak, MD; Frances Philp, MS; Mark C. Miller, PhD; Daniel T Altman, MD; Gregory T Altman, MD
Allegheny General Hospital, Pittsburgh, PA
Purpose: Evaluate upper extremity injuries from the sternum to the wrist from a Level I trauma center and compare the associated non-bony injuries and their outcomes in patients < 60 and > 60 years old.
Methods: A retrospective analysis of an institutional trauma registry identified upper extremity injuries treated from 2007-2015 at a Level I trauma center. Patients 18 to over 100 years old with isolated injuries from the sternum to the wrist were included. Patients <18 years of age, or any patients with operative lower extremity fractures were excluded. Patients were divided into two groups: young (18-60) and elderly (>60). A sub-group analysis of the elderly group was also performed by age: 60-69, 70-79, and >80 years old. Multiple isolated and combined upper extremity injuries were analyzed. General demographics, injury mechanism, associated non-bony injuries (e.g. head, thoracic, great vessel, nerve), injury severity score (ISS), inpatient mortality, and discharge destination were compared between age groups. The relative risk (RR) of suffering a head or thoracic injury was determined for different upper extremity injuries. Statistical comparisons were performed between groups and a p-value <0.05 was deemed to be statistically significant.
Results: Out of a registry (Level 1, 2, or 3 alerts) of 26,165 patients there were 2254 and 1494 patients aged 18-59 and > 60 years old, respectively, that fit our inclusion criteria. Comparative results are shown in Figure 1. Compared to the elderly, there was a significantly higher rate of high-energy mechanisms and discharges to home, and a significantly lower rate of in-hospital mortality for the young. There were no significant differences between groups for associated non-bony injury patterns. However, head injuries were higher in the elderly, thoracic injuries were higher in the young, and great vessel injuries were similar for both. Within the elderly sub-groups, patients >80 had a significantly higher rate of in-hospital mortality and head injuries. For different upper extremity patterns, the ISS was not significantly different except for sternum + clavicle patients. As seen in the graphs of Figure 2, the elderly had a higher in-hospital mortality rate, and a higher RR of head or thoracic injuries across the majority of the upper extremity injuries, especially most shoulder girdle injuries. However, shoulder dislocations and distal upper extremity injuries had similar RR.
Summary: In admitted trauma patients with upper extremity injuries, patients > 60 have distinct injury patterns and worse outcomes then patients < 60 years old.
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