Dynamic vital signs may predict in-hospital mortality in elderly trauma patients

Vital signs (VS) are dynamic parameters and understanding the significance of changes in VS in the acute setting may offer clinical meaning. We aimed to measure dynamic changes in vital signs (ΔVS) between site of trauma and presentation to hospital and investigate the association between ΔVS and in-hospital mortality among elderly with trauma. We conducted a retrospective cohort study between 2004 and 2015 using data from the nationwide trauma registry. Patients aged ≥75 years were included. Data were collected at scene of trauma and at arrival of emergency department (ED) in Japan with blunt or penetrating trauma. ΔVS scoring was defined based on clinical implications and previous reports. One point was given for each of the following criteria: systolic blood pressure reduction (-ΔSBP) of ≥30 mm Hg, heart rate increase (ΔHR) of ≥20/minute, and respiratory rate increase (ΔRR) of ≥10/minute between site of trauma and ED. The primary outcome was in-hospital mortality. Of 236,698 patients in the registry, data from 28,860 eligible patients (12.2%) were analyzed [mean age (SD), 83.2 (0.3); males, 57%]. Overall in-hospital mortality rate was 10.0%. In-hospital mortality increased from 9.0% to 16.5% for -ΔSBP; 9.2% to 22.2% for ΔHR; and 9.7% to 15.9% for ΔRR. ΔVS scores of 0, 1, 2, and 3 points were associated with in-hospital mortality of 8.2%, 14.9%, 30.1%, and 50.0%, respectively. A score based on the dynamic changes of VS, ΔVS score, may be helpful in predicting in-hospital mortality among elderly with trauma.