Complications Resulting From Trauma Increase With Age

NEW ORLEANS — The risks of pneumonia and other serious infectious and septic complications of traumatic injury climb steadily in age-dependent fashion.

This finding from an analysis of data from the world's largest trauma registry suggests that the immune response to trauma varies with age and that the neuroendocrine axis is involved in this immunoactivation, Dr. Christian D. McClung observed at the annual scientific sessions of the American Heart Association.

He reported on 857,046 patients aged 5–89 years included in the American College of Surgeons National Trauma Data Bank for 2000–2004. The patients were hospitalized at more than 600 participating trauma centers, with a median 3-day length of stay. The mean age of the study population was 40 years. Two-thirds were male. The mortality rate was 4.4%.

Pneumonia was a complication of trauma in 1.6% of cases, acute respiratory distress syndrome (ARDS) in 0.5%, and bacteremia in 0.13%, said Dr. McClung, an emergency physician at Los Angeles County-USC Medical Center, Los Angeles.

The risks of pneumonia, bacteremia, and ARDS rose with each decade of age in a multivariate logistic regression analysis adjusted for potential confounders including age, sex, injury severity score, trauma mechanism, and days on a ventilator. The 56,680 children aged 5–12 years served as the comparison group. (See box, page 14).

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