Comparison of the epidemiology of elderly trauma between major trauma centres in Riyadh, Saudi Arabia and Melbourne, Australia

Zisis Touloumis; Sharfuddin M. Chowdhury; Mark C. Fitzgerald; Mansour I. Aljabri; Margot E. Lodge; Jane E. Ford; Joseph K. Mathew; Christopher J. Groombridge

doi:10.15537/smj.2024.45.10.20240307

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Table 1

- Characteristics of the Saudi Trauma Registry and the Alfred Hospital Trauma Registry cohort.

Characteristics	KSMC (n=193)	Alfred (n=1233)	P-values
Gender
Female	60 (31.1)	547 (44.4)	<0.001
Male	133 (68.9)	686 (55.6)	<0.001
Age in years at event, mean±SD	76.1±8.6	78.8±8.4	<0.001
Cause of injury
Falls-low (<1m)	116 (60.1)	751 (60.9)	<0.001
Falls-high (>1m)	11 (5.7)	155 (12.6)
Burns-all types	4 (2.1)	19 (1.5)
Cutting, piercing object	1 (0.5)	6 (0.5)
Motor vehicle occupants	38 (19.7)	150 (12.2)
Motorcyclists	0 (0.0)	14 (1.1)
Other specified external cause	1 (0.5)	31 (2.5)
Pedal cyclist	0 (0.0)	50 (4.1)
Pedestrian	17 (8.8)	38 (3.1)
Struck by object or person	4 (2.1)	18 (1.5)
Unspecified external cause	1 (0.5)	1 (0.1)
Injury severity score range
<12	142 (73.6)	672 (54.5)	<0.001
12–25	43 (22.3)	467 (37.9)
26–40	7 (3.6)	88 (7.1)
>40	1 (0.5)	6 (0.5)
Crude outcome measures
Discharge destination
Death	20 (10.4)	100 (8.1)	<0.001
Home	167 (86.5)	690 (56.0)
Nursing home	0 (0.0)	93 (7.5)
Other	0 (0.0)	2 (0.2)
Transferred to another hospital for ongoing acute care	5 (2.6)	0 (0.0)
Transferred to another hospital for rehabilitation or convalescence	1 (0.5)	348 (28.2)
Deceased at discharge
No	173 (89.6)	1133 (91.9)	0.29
Yes	20 (10.4)	100 (8.1)	0.29
Length of stay, median (IQR)	10.0 (7.0-17.0)	6.8 (3.5-11.8)	<0.001

Values are presented as numbers and percentages (%).

KSMC: King Saud Medical City, SD: standard deviation, IQR: interquartile range

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Table 2

- Risk-adjusted length of stay (N=1426).

Variables	Coefficient	95% CI		P-values
Variables	Coefficient	Upper	Lower	P-values
KSMC	1.00			Reference
Alfred	-4.51	-5.77	-3.25	<0.001
Glasgow coma score motor (arrival)
Obeys commands	1.00			Reference
Localises pain	-0.78	-3.31	1.74	0.54
Withdraws to pain	6.46	-0.22	13.14	0.06
Flexion to pain	-4.17	-9.67	1.34	0.14
Extension to pain	-7.57	-21.98	6.83	0.30
None	0.33	-1.76	2.42	0.76
Not stated	-0.52	-5.06	4.02	0.82
Injury severity score range
<12	1.00			Reference
12-25	0.72	-0.48	1.92	0.24
26-40	1.20	-1.63	4.04	0.41
>40	-3.31	-10.73	4.10	0.38
Age at injury event (years)
65-74	1.00			Reference
75-84	0.33	-0.58	1.24	0.48
85-94	0.52	-0.59	1.64	0.36
95+	1.84	-0.42	4.10	0.11
Chest injury severity
No chest injury	1.00			Reference
Minor	0.29	-1.73	2.31	0.78
Moderate	0.03	-1.58	1.63	0.97
Serious	1.07	-0.04	2.18	0.06
Severe	7.52	4.52	10.52	<0.001
Critical	-2.33	-9.65	4.99	0.53
Abdominal injury severity
No abdominal injury	1.00			Reference
Minor	0.59	-6.01	7.19	0.86
Moderate	1.40	-0.63	3.44	0.18
Serious	2.29	-1.63	6.22	0.25
Severe	6.16	1.41	10.92	0.01
Critical	3.30	-7.15	13.75	0.54
Spinal injury severity
No spinal injury	1.00			Reference
Minor	2.19	-1.84	6.22	0.29
Moderate	1.90	0.97	2.84	<0.001
Serious	1.81	0.32	3.31	0.02
Severe	5.23	0.68	9.78	0.02
Critical	-1.05	-9.50	7.41	0.81
Upper-limb injury severity
No upper-limb injury	1.00			Reference
Minor	0.35	-2.94	3.63	0.84
`Moderate	0.16	-0.91	1.23	0.77
Serious	-1.06	-11.31	9.20	0.84
Lower-limb injury severity
No lower-limb injury	1.00			Reference
Minor	0.36	-7.92	8.64	0.93
Moderate	2.11	0.64	3.59	0.01
Serious	3.91	2.53	5.30	<0.001
Severe	4.86	0.96	8.75	0.02
Critical	-0.60	-8.99	7.79	0.89
Other injury or burn severity
No other or burn injury	1.00			Reference
Minor	-0.45	-1.31	0.41	0.31
Moderate	-0.90	-3.00	1.21	0.41
Serious	-2.26	-7.17	2.65	0.37
Severe	5.20	-4.32	14.72	0.28
Critical	-21.57	-29.13	-14.02	<0.001
Head injury severity
No head injury	1.00			Reference
Moderate	0.70	-1.20	2.60	0.47
Serious	1.34	-0.13	2.80	0.07
Severe	3.34	1.06	5.62	<0.001
Critical	2.49	-0.36	5.34	0.09
Mechanism of injury
Falls-low (<1m)	1.00			Reference
Falls-high (>1m)	-1.30	-2.60	0.00	0.05
Burns-all types	17.10	12.65	21.54	<0.001
Cutting, piercing object	2.57	-2.94	8.07	0.36
Motor vehicle occupants	0.05	-1.22	1.32	0.94
Motorcyclists	-1.32	-5.29	2.64	0.51
Other specified external cause	-1.37	-4.00	1.27	0.31
Pedal cyclist	-2.83	-4.97	-0.69	0.01
Pedestrian	-2.15	-4.24	-0.07	0.04
Struck by object or person	-2.79	-5.97	0.39	0.09
Unspecified external cause	0.78	-9.34	10.91	0.88

KSMC: King Saud Medical City, CI: confidence interval

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Table 3

- Risk-adjusted mortality (N=1416).

Variables	Odds ratio	95% CI		P-values
Variables	Odds ratio	Upper	Lower	P-values
KSMC	1.00			Reference
Alfred	0.72	0.36	1.47	0.37
Glasgow coma score motor (arrival)
Obeys commands	1.00			Reference
Localises pain	8.37	3.71	18.89	<0.001
Withdraws to pain	3.40	0.31	36.97	0.32
Flexion to pain	50.05	8.43	297.27	<0.001
Extension to pain	1.00
None	22.02	11.07	43.82	<0.001
Not stated	4.49	0.73	27.48	0.10
Injury severity score range
<12	1.00			Reference
12-25	1.48	0.89	2.45	0.13
26-40	5.03	2.51	10.10	<0.001
>40	15.23	1.93	120.07	0.01
Age at injury event (years)
65-74	1.00			Reference
75-84	1.58	0.86	2.93	0.14
85-94	5.60	2.90	10.81	<0.001
95+	5.83	1.97	17.27	<0.001
Mechanism of injury
Falls-low (<1m)	1.00			Reference
Falls-high (>1m)	0.72	0.30	1.70	0.45
Burns-all types	3.94	1.30	11.97	0.02
Cutting, piercing object	1.00
Motor vehicle occupants	0.68	0.31	1.51	0.34
Motorcyclists	0.91	0.07	12.11	0.94
Other specified external cause	0.69	0.13	3.63	0.67
Pedal cyclist	0.64	0.12	3.34	0.59
Pedestrian	1.77	0.55	5.66	0.33
Struck by object or person	3.80	0.90	16.07	0.07