It is time for a change in the management of elderly severely injured patients! An analysis of 126,015 patients from the TraumaRegister DGU®

  • Christopher SperingEmail author
  • Rolf Lefering
  • Bertil Bouillon
  • Wolfgang Lehmann
  • Kajetan von Eckardstein
  • Klaus Dresing
  • Stephan Sehmisch
Original Article



The number of elderly patients among the severely injured has been increasing continuously. It has been suggested that an increased life expectancy and a higher level of activity and mobility in older ages could explain this observation. Elderly trauma patients have relevant higher mortality rates and poorer functional outcomes. The reasons remain unclear. The aim of this study was to look for differences in the management of severely injured elderly patients compared to younger age groups and to evaluate their potential impact on outcome.


The TraumaRegister DGU® is a multicenter database that documents de-identified data of severely injured patients since 1993. Trauma cases documented between 2009 and 2016 with an ISS ≥ 9 were divided in four age groups. The groups were compared with respect to mechanism of injury, pattern of injury, severity of injury, management and outcome.


The analysis of 126,015 severely injured patients showed that 37.5% of the population were elderly patients (≥ 60 years). Their rate actually increased every year by 1.7%. The elderly trauma patients experience different mechanisms of injury (more low energy trauma) and different pattern of injuries (more brain trauma, less abdominal and extremity injuries). Evaluating the management of patients showed that elderly patients have lower intubation rates and less volume replacement in the prehospital setting. Diagnostic interventions like CT scans in the emergency room were performed more restrictively. Elderly trauma patients also received fewer surgical interventions for brain injuries, pelvic fractures and femur fractures. Their hospital mortality rates were higher.


Severely injured elderly patients are treated with a more “wait and see approach” resulting in higher mortality rates. We suggest that this population needs a more “aggressive management” to improve their outcome, if the wish to perform complete treatment including surgical procedures and intensive care medicine has not been excluded by the patients or their legal guardian.


Severely injured elderly Polytrauma Management of multiple injured elderly 



The authors would like to thank Deborah A. Landry, B.A. for her help in preparing the manuscript.

Compliance with ethical standards

Conflict of interest

The authors are aware of no conflicts of interest, financial or otherwise, related to this work.


  1. 1.
    Calland JF, Ingraham AM, Martin N, Marshall GT, Schulman CI, Stapleton T, Barraco RD, Eastern Association for the Surgery of Trauma. Evaluation and management of geriatric trauma: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5):345–50.CrossRefGoogle Scholar
  2. 2.
    Calland JF, Xin W, Stukenborg GJ. Effects of leading mortality risk factors among trauma patients vary by age. J Trauma Acute Care Surg. 2013;75(3):501–5.CrossRefGoogle Scholar
  3. 3.
    Chang WH, Tsai SH, Su YJ, Huang CH, Chang KS, Tsai CH. Trauma Mortality Factors in the Elderly Population. Int J Gerontology. 2008;2:11–7.CrossRefGoogle Scholar
  4. 4.
    Chiang WK, Huang ST, Chang WH, Huang MY, Chien DK, Tsai CH. Int J Gerontology. 2012;6:192–5.CrossRefGoogle Scholar
  5. 5.
    Dinh MM, Russell SB, Bein KJ, Vallmuur K, Muscatello D, Chalkley D, Ivers R. Age-related trends in injury and injury severity presenting to emergency departments in New South Wales Australia: implications for major injury surveillance and trauma sytems. Injury. 2017;48:171–6.CrossRefGoogle Scholar
  6. 6.
    Giannoudis PV, Harwood PJ, Court-Brown C, Pape HC. Severe and multiple trauma in older patients: incidence and mortality. Injury. 2009;40:362–7.CrossRefGoogle Scholar
  7. 7.
    Herou E, Romner B, Tomasevic G. Acute traumatic brain injury: mortality in the elderly. World Neurosurg. 2015;83(6):996–1001.CrossRefGoogle Scholar
  8. 8.
    Hranjec T, Sawyer RG, Young JS, Swenson BR, Calland JF. Mortality factors in geriatric blunt trauma patients: creation of a highly predictive statistical model for mortality using 50,765 consecutive elderly trauma admissions from the national sample project. Am Surg. 2012;78(12):1369–75.Google Scholar
  9. 9.
    Ichwan B, Darbha S, Shah MN, Thompson L, Evans DC, Boulger CT, Caterino JM. Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults. Ann Emerg med. 2015;65(1):92–100.CrossRefGoogle Scholar
  10. 10.
    Jacobs DG, Plaisier BR, Barie PS, Hammond JS, Holevar MR, Sinclair KE, Scalea TM, Wahl W, EAST Practice management guidelines Work Group. Practice Management Guidelines for geriatric trauma: the EAST Practice Management Guidelines Group. J Trauma. 2003;54:391–416.CrossRefGoogle Scholar
  11. 11.
    Kozar RA, Arbabi S, Sm Stein, Shackford SR, Barraco RD, Biffl WL, Brasel KJ, Cooper Z, Fakhry SM, Livingston D, Moore F, Luchette F. Injury in the aged: geriatric trauma care at the crossroads. J Trauma Acute Care Surg. 2015;78(6):1197–209.CrossRefGoogle Scholar
  12. 12.
    Kuehne CA, Ruchholtz S, Kaiser GM, Nast-Kolb D, Working Group on Multiple Trauma of the German Society of Trauma. Mortality in severely injured elderly trauma patients–when does age become a risk factor? World J Surg. 2005;29(11):1476–82.CrossRefGoogle Scholar
  13. 13.
    Lefering R, Huber-Wagner S, Nienaber U, Maegele M, Bouillon B. Update of the trauma risk adjustment model of the TraumaRegister DGU: the revised injury severity classification, version II. Crit Care. 2014;18:476.CrossRefGoogle Scholar
  14. 14.
    Moore L, Turgeon AF, Sirois MJ, Lavoie A. Trauma centre outcome performance: a comparison of young adults and geriatric patients in an inclusive trauma system. Injury. 2012;43:1580–5.CrossRefGoogle Scholar
  15. 15.
    Morrissey N, Iliopoulos E, Osmani AW, Newman K. Neck of femur fractures in the elderly: does every hour to surgery count? Injury. 2017;48(6):1155–8.CrossRefGoogle Scholar
  16. 16.
    Sammy I, Lecky F, Sutton A, Leaviss J, O’Cathain A. Factors affecting mortality in older trauma patients—a systematic review and meta-analysis. Injury. 2016;47:1170–83.CrossRefGoogle Scholar
  17. 17.
    Statistisches Bundesamt, Wiesbaden (2011) Ältere Menschen in Deutschland und der EU. Im Blickpunkt 1021221–11900–4.Google Scholar
  18. 18.
    Wutzler S, Lefering R, Laurer HL, Walcher F, Wyen H, Marzi I. Changes in geriatric traumatology. An analysis of 14,869 patients from the German Trauma Registry. Unfallchirurg. 2008;111:592–8.CrossRefGoogle Scholar
  19. 19.
    Wutzler S, Lefering R, Wafaisade A, Maegele M, Lustenberger T, Walcher F, Marzi I, Laurer H, TraumaRegisterDGU. Aggressive operative treatment of isolated blunt traumatic brain injury in the elderly is associated with favourable outcome. Injury. 2015;46:1706–11.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Trauma Surgery, Orthopaedics and Plastic SurgeryUniversity of Göttingen Medical CenterGöttingenGermany
  2. 2.Institute for Research in Operative Medicine (IFOM)University of Witten/HerdeckeCologneGermany
  3. 3.Department of Trauma Surgery, Orthopeadics and Sports TraumatologyUniversity of Witten/HerdeckeWittenGermany
  4. 4.Department of NeurosurgeryUniversity of Göttingen Medical CenterGöttingenGermany

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