Abdominal organs injuries.

Background
The growing geriatric population has specific medical characteristics that should be taken into account especially in trauma setting. There is little evidence on management of abdominal trauma in the elderly and this article compares the management and outcomes of younger and older patients in order to highlight fields of improvement.
Method
We conducted a retrospective database analysis from two European university hospitals selecting patients admitted for abdominal injury and extracted the following data: epidemiological data, mechanisms of the trauma, vital signs, blood tests, injuries, applied treatments, trauma scores and outcomes. We compared to different age group (16–64 and 65+ years old) using uni- and multivariable analysis.
Results
1181 patients were included for statistical analysis. The main mechanisms of injury in both group were traffic accidents and in the elderly group, falls were more frequent. Both had similar Abbreviated Injury Score except for the thoracic injuries, which was higher in the elderly group. We reported a death rate of 13% in the elderly group and 7% in the younger group. However, multivariable analysis did not report age as an independent predictor of mortality. The management including surgery, blood transfusion and need for intensive care were similar in both groups.
Conclusion
Although elderly patients suffering abdominal trauma have an almost two fold higher mortality, their management is quite similar leading to an important point of improvement in regards to triage and lower threshold for more aggressive management and surveillance. Age itself does not seem to be a reliable predictor of mortality. Introducing a frailty score when taking care of elderly trauma patients could improve the outcomes.

研究背景
日益增长的老年人口具有独特的医学特征，尤其在创伤诊疗场景中需予以重点关注。目前针对老年人群腹部创伤诊疗的相关研究证据较为匮乏，本文通过对比年轻与老年腹部创伤患者的诊疗方案与结局，以期明确可优化的方向。
研究方法
本研究依托两家欧洲大学附属医院的数据库开展回顾性分析，纳入因腹部损伤入院的患者，并提取以下信息：流行病学资料、创伤致伤机制、生命体征、血液检验指标、损伤情况、实施的治疗方案、创伤评分及诊疗结局。采用单变量及多变量分析方法，对比两个年龄组（16~64岁与65岁及以上）患者的相关情况。
研究结果
本研究共纳入1181例患者进行统计分析。两组患者的主要致伤原因均为交通事故，但老年组中跌倒致伤的占比更高。两组患者的简明损伤定级标准（Abbreviated Injury Scale, AIS）评分总体相近，但老年组的胸部损伤评分显著更高。本研究中，老年组患者的病死率为13%，年轻组为7%。但多变量分析结果显示，年龄并非病死率的独立预测因素。两组患者的治疗方案（包括手术治疗、输血及重症监护需求）并无显著差异。
研究结论
尽管腹部创伤老年患者的病死率较年轻患者高出近一倍，但二者的诊疗方案却较为相近，这提示我们在创伤分诊及降低积极治疗与病情监测的阈值方面存在重要的优化空间。年龄本身并非可靠的病死率预测因素。在收治老年创伤患者时引入衰弱评分，或可改善其诊疗结局。