Age and mortality after injury

is the association linear?

R. S. Friese, J. Wynne, B. Joseph, A. Hashmi, C. Diven, V. Pandit, Terence OKeeffe, B. Zangbar, N. Kulvatunyou, P. Rhee

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Conclusions: The risk of death after injury varies linearly with age until 84 years. After 84 years of age, the mortality rates decline. These findings may reflect the varying severity of comorbidities and differences in baseline functional status in elderly trauma patients. Specifically, a proportion of our injured patient population less than 84 years old may be more frail, contributing to increased mortality after trauma, whereas a larger proportion of our injured patients over 84 years old, by virtue of reaching this advanced age, may, in fact, be less frail, contributing to less risk of death.

Introduction: Multiple studies have demonstrated a linear association between advancing age and mortality after injury. An inflection point, or an age at which outcomes begin to differ, has not been previously described. We hypothesized that the relationship between age and mortality after injury is non-linear and an inflection point exists.

Methods: We performed a retrospective cohort analysis at our urban level I center from 2007 through 2009. All patients aged 65 years and older with the admission diagnosis of injury were included. Non-parametric logistic regression was used to identify the functional form between mortality and age. Multivariate logistic regression was utilized to explore the association between age and mortality. Age 65 years was used as the reference. Significance was defined as p < 0.05.

Results: A total of 1,107 patients were included in the analysis. One-third required intensive care unit (ICU) admission and 48 % had traumatic brain injury. 229 patients (20.6 %) were 84 years of age or older. The overall mortality was 7.2 %. Our model indicates that mortality is a quadratic function of age. After controlling for confounders, age is associated with mortality with a regression coefficient of 1.08 for the linear term (p = 0.02) and a regression coefficient of −0.006 for the quadratic term (p = 0.03). The model identified 84.4 years of age as the inflection point at which mortality rates begin to decline.

Original languageEnglish (US)
Pages (from-to)567-572
Number of pages6
JournalEuropean Journal of Trauma and Emergency Surgery
Volume40
Issue number5
DOIs
StatePublished - Oct 16 2014
Externally publishedYes

Fingerprint

Mortality
Wounds and Injuries
Logistic Models
Intensive Care Units
Comorbidity
Cohort Studies
Population

Keywords

  • Geriatric trauma
  • Intensive care unit admission and old age
  • Old age and mortality
  • Outcome is elderly trauma patients

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Friese, R. S., Wynne, J., Joseph, B., Hashmi, A., Diven, C., Pandit, V., ... Rhee, P. (2014). Age and mortality after injury: is the association linear? European Journal of Trauma and Emergency Surgery, 40(5), 567-572. https://doi.org/10.1007/s00068-014-0380-0

Age and mortality after injury : is the association linear? / Friese, R. S.; Wynne, J.; Joseph, B.; Hashmi, A.; Diven, C.; Pandit, V.; OKeeffe, Terence; Zangbar, B.; Kulvatunyou, N.; Rhee, P.

In: European Journal of Trauma and Emergency Surgery, Vol. 40, No. 5, 16.10.2014, p. 567-572.

Research output: Contribution to journalArticle

Friese, RS, Wynne, J, Joseph, B, Hashmi, A, Diven, C, Pandit, V, OKeeffe, T, Zangbar, B, Kulvatunyou, N & Rhee, P 2014, 'Age and mortality after injury: is the association linear?', European Journal of Trauma and Emergency Surgery, vol. 40, no. 5, pp. 567-572. https://doi.org/10.1007/s00068-014-0380-0
Friese, R. S. ; Wynne, J. ; Joseph, B. ; Hashmi, A. ; Diven, C. ; Pandit, V. ; OKeeffe, Terence ; Zangbar, B. ; Kulvatunyou, N. ; Rhee, P. / Age and mortality after injury : is the association linear?. In: European Journal of Trauma and Emergency Surgery. 2014 ; Vol. 40, No. 5. pp. 567-572.
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abstract = "Conclusions: The risk of death after injury varies linearly with age until 84 years. After 84 years of age, the mortality rates decline. These findings may reflect the varying severity of comorbidities and differences in baseline functional status in elderly trauma patients. Specifically, a proportion of our injured patient population less than 84 years old may be more frail, contributing to increased mortality after trauma, whereas a larger proportion of our injured patients over 84 years old, by virtue of reaching this advanced age, may, in fact, be less frail, contributing to less risk of death.Introduction: Multiple studies have demonstrated a linear association between advancing age and mortality after injury. An inflection point, or an age at which outcomes begin to differ, has not been previously described. We hypothesized that the relationship between age and mortality after injury is non-linear and an inflection point exists.Methods: We performed a retrospective cohort analysis at our urban level I center from 2007 through 2009. All patients aged 65 years and older with the admission diagnosis of injury were included. Non-parametric logistic regression was used to identify the functional form between mortality and age. Multivariate logistic regression was utilized to explore the association between age and mortality. Age 65 years was used as the reference. Significance was defined as p < 0.05.Results: A total of 1,107 patients were included in the analysis. One-third required intensive care unit (ICU) admission and 48 {\%} had traumatic brain injury. 229 patients (20.6 {\%}) were 84 years of age or older. The overall mortality was 7.2 {\%}. Our model indicates that mortality is a quadratic function of age. After controlling for confounders, age is associated with mortality with a regression coefficient of 1.08 for the linear term (p = 0.02) and a regression coefficient of −0.006 for the quadratic term (p = 0.03). The model identified 84.4 years of age as the inflection point at which mortality rates begin to decline.",
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AU - Wynne, J.

AU - Joseph, B.

AU - Hashmi, A.

AU - Diven, C.

AU - Pandit, V.

AU - OKeeffe, Terence

AU - Zangbar, B.

AU - Kulvatunyou, N.

AU - Rhee, P.

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N2 - Conclusions: The risk of death after injury varies linearly with age until 84 years. After 84 years of age, the mortality rates decline. These findings may reflect the varying severity of comorbidities and differences in baseline functional status in elderly trauma patients. Specifically, a proportion of our injured patient population less than 84 years old may be more frail, contributing to increased mortality after trauma, whereas a larger proportion of our injured patients over 84 years old, by virtue of reaching this advanced age, may, in fact, be less frail, contributing to less risk of death.Introduction: Multiple studies have demonstrated a linear association between advancing age and mortality after injury. An inflection point, or an age at which outcomes begin to differ, has not been previously described. We hypothesized that the relationship between age and mortality after injury is non-linear and an inflection point exists.Methods: We performed a retrospective cohort analysis at our urban level I center from 2007 through 2009. All patients aged 65 years and older with the admission diagnosis of injury were included. Non-parametric logistic regression was used to identify the functional form between mortality and age. Multivariate logistic regression was utilized to explore the association between age and mortality. Age 65 years was used as the reference. Significance was defined as p < 0.05.Results: A total of 1,107 patients were included in the analysis. One-third required intensive care unit (ICU) admission and 48 % had traumatic brain injury. 229 patients (20.6 %) were 84 years of age or older. The overall mortality was 7.2 %. Our model indicates that mortality is a quadratic function of age. After controlling for confounders, age is associated with mortality with a regression coefficient of 1.08 for the linear term (p = 0.02) and a regression coefficient of −0.006 for the quadratic term (p = 0.03). The model identified 84.4 years of age as the inflection point at which mortality rates begin to decline.

AB - Conclusions: The risk of death after injury varies linearly with age until 84 years. After 84 years of age, the mortality rates decline. These findings may reflect the varying severity of comorbidities and differences in baseline functional status in elderly trauma patients. Specifically, a proportion of our injured patient population less than 84 years old may be more frail, contributing to increased mortality after trauma, whereas a larger proportion of our injured patients over 84 years old, by virtue of reaching this advanced age, may, in fact, be less frail, contributing to less risk of death.Introduction: Multiple studies have demonstrated a linear association between advancing age and mortality after injury. An inflection point, or an age at which outcomes begin to differ, has not been previously described. We hypothesized that the relationship between age and mortality after injury is non-linear and an inflection point exists.Methods: We performed a retrospective cohort analysis at our urban level I center from 2007 through 2009. All patients aged 65 years and older with the admission diagnosis of injury were included. Non-parametric logistic regression was used to identify the functional form between mortality and age. Multivariate logistic regression was utilized to explore the association between age and mortality. Age 65 years was used as the reference. Significance was defined as p < 0.05.Results: A total of 1,107 patients were included in the analysis. One-third required intensive care unit (ICU) admission and 48 % had traumatic brain injury. 229 patients (20.6 %) were 84 years of age or older. The overall mortality was 7.2 %. Our model indicates that mortality is a quadratic function of age. After controlling for confounders, age is associated with mortality with a regression coefficient of 1.08 for the linear term (p = 0.02) and a regression coefficient of −0.006 for the quadratic term (p = 0.03). The model identified 84.4 years of age as the inflection point at which mortality rates begin to decline.

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KW - Intensive care unit admission and old age

KW - Old age and mortality

KW - Outcome is elderly trauma patients

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