Gunshot Injuries in the Elderly: Patterns and Outcomes. A National Trauma Databank Analysis Thomas Lustenberger • Kenji Inaba • Beat Schnu ¨riger • Galinos Barmparas • Barbara M. Eberle • Lydia Lam • Peep Talving • Demetrios Demetriades Published online: 4 January 2011 Ó Socie ´te ´ Internationale de Chirurgie 2010 Abstract Background Trauma in the elderly (C55 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. Methods 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 C55 years old were assigned to one of three categorical strata: 55–64 years old, 65–74 years old, and C75 years old. Results During the study period, 98,242 patients were admitted for firearm-related injuries, and 3,190 (3.2%) of them were C55 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 C75 years old. The incidence of severe trauma [Injury Severity Score (ISS) C 16] in the elderly age strata was 43.3, 46.8, and 57.6%, respectively (p \ 0.001). Patients C75 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% respec- tively; 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 C75 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) B 8, an ISS C 16, hypotension on admission, age, self-inflicted injury, and injury sustained by assault were factors inde- pendently associated with death in patients C55 years. Conclusions 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 sus- tain a high burden of injury and a high rate of mortality, which increases with advancing age. Introduction The geriatric population is the fastest growing age group today [1], and trauma to this age segment of the population accounts for a significant proportion of admissions to trauma centers. Classically, injuries sustained by elderly patients were thought to be blunt, consisting primarily of falls, motor vehicle collisions, and pedestrian events. However, penetrating injuries, particularly involving fire- arms, were recently reported by the Centers for Diseases Control and Prevention to account for over 50% of assault- related fatal injuries in the elderly [2]. Very few studies exist examining the impact of penetrating injuries on the geriatric population [3, 4]. Contemporary, nationwide epidemiologic data on firearm-related injuries in elderly T. Lustenberger Á K. Inaba (&) Á B. Schnu ¨riger Á G. Barmparas Á B. M. Eberle Á L. Lam Á P. Talving Á D. Demetriades Division of Trauma and Critical Care, Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles County General Hospital (LAC ? USC), 1200 North State Street, IPT, C5L100, Los Angeles, CA 90033-4525, USA e-mail: kinaba@surgery.usc.edu 123 World J Surg (2011) 35:528–534 DOI 10.1007/s00268-010-0920-7