Gunshot Injuries in the Elderly: Patterns and Outcomes. A National Trauma Databank Analysis

Trauma in the elderly (a parts per thousand yen55 years) accounts for a significant proportion of admissions to trauma centers. Our understanding of the epidemiology and outcomes associated with penetrating injury in this age segment of the population, however, is severely limited. The aim of the present study therefore was to investigate the incidence and type of injuries sustained by elderly patients from firearms and the impact of age on outcomes. This was a 5-year National Trauma Databank (NTDB) study. Injury demographics, mortality rates, and lengths of stay in the Intensive Care Unit (ICU) and the hospital were analyzed. Elderly patients a parts per thousand yen55 years old were assigned to one of three categorical strata: 55-64 years old, 65-74 years old, and a parts per thousand yen75 years old. During the study period, 98,242 patients were admitted for firearm-related injuries, and 3,190 (3.2%) of them were a parts per thousand yen55 years old. Within the elderly age segment of the population, 1,676 patients (52.5%) were 55-64 years of age, 727 (22.8%) were 65-74 years of age, and 787 (24.7%) were a parts per thousand yen75 years old. The incidence of severe trauma [Injury Severity Score (ISS) a parts per thousand yen 16] in the elderly age strata was 43.3, 46.8, and 57.6%, respectively (p < 0.001). Patients a parts per thousand yen75 years old were significantly more likely than patients 55-74 years old to suffer self-inflicted injuries. The most commonly encountered injury in elderly patients was gunshot wounds to the head, which increased in a stepwise fashion with advancing age (25.8, 31.6, and 39.4% respectively; p < 0.001). The crude mortality rate in all patients sustaining gunshot wounds increased progressively with age. Within the elderly age segment, mortality ranged from 28.5% in the age stratum 55-64 years, to 55.4% in the stratum a parts per thousand yen75 years (adjusted p < 0.001). Intensive care unit and hospital length of stay increased with advancing age but peaked and remained stable among the elderly age groups. An admission Glasgow Coma Score (GCS) a parts per thousand currency sign 8, an ISS a parts per thousand yen 16, hypotension on admission, age, self-inflicted injury, and injury sustained by assault were factors independently associated with death in patients a parts per thousand yen55 years. Injury from firearms is not uncommon in the elderly patient population and is primarily a result of self-inflicted gunshot wounds to the head. These patients sustain a high burden of injury and a high rate of mortality, which increases with advancing age.