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Polytrauma in the Geriatric Population: Analysis of Outcomes for Surgically Treated Multiple Fractures with a Minimum 2 Years of Follow-Up. Adv Ther 2022; 39:2139-2150. [PMID: 35294739 DOI: 10.1007/s12325-022-02109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/01/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION This study analyzed the clinical and radiological outcomes of geriatric polytrauma patients who had multiple fractures surgically treated and a minimum of 2 years of follow-up. METHODS Eighty-six geriatric patients with polytrauma and multiple fractures which were surgically treated in orthopedics and who had a minimum of 2 years of follow-up were retrospectively analyzed. Patients' demographic characteristics, comorbidities, and follow-up time were recorded. The mechanism of injury, fracture type and location, Injury Severity Score (ISS), American Society of Anesthesiologists (ASA) score, duration of hospital stay, complications, and 1-year mortality were also recorded. Fracture union, implant failure, and refractures/misalignment were analyzed from radiographs. RESULTS There were 34 (39.5%) male and 52 (60.5%) female patients. Mean age was 73.5 years with an average follow-up time of 32.9 months. Patients had more low-energy traumas and more lower extremity, comminuted fractures. On the contrary, high-energy traumas and femur/pelvic fracture surgeries had higher associated mortality. The mean ISS score was 26.3. The most common ASA score was ASA 3 (75.8%). The most common clinical and radiological complications were prolonged wound drainage and implant failure. The total 1-year mortality rate was 22.1%. Patients with high ASA scores and patients with lower extremity fractures (femoral/pelvic fractures) also had significantly increased mortality rates. No significant relation was detected between mortality and ISS, fracture type, number of fractures, and duration of hospital stay. CONCLUSION Orthopedic surgeons must be alert about the possible complications of femoral fractures and comminuted fractures including pelvic girdle. Surgically treated, multifractured patients with high-energy trauma, advanced age, and high ASA scores are also at risk for mortality regardless of the ISS, comorbidities, and duration of hospital stay. Pulmonary thromboemboli must be kept in mind as a significant complication for mortality.
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Jensen KO, Lempert M, Sprengel K, Simmen HP, Pothmann C, Schlögl M, Bischoff-Ferrari HA, Hierholzer C, Pape HC, Neuhaus V. Is There Any Difference in the Outcome of Geriatric and Non-Geriatric Severely Injured Patients?-A Seven-Year, Retrospective, Observational Cohort Study with Matched-Pair Analysis. J Clin Med 2020; 9:jcm9113544. [PMID: 33153102 PMCID: PMC7692238 DOI: 10.3390/jcm9113544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022] Open
Abstract
Geriatric trauma is expected to increase due to the lifestyle and activity of the aging population and will be among the major future challenges in health care. Therefore, the aim of this study was to investigate differences between polytraumatized geriatric and non-geriatric patients regarding mortality, length-of-stay and complications with a matched pair analysis. We included patients older than 17 years with an Injury Severity Score (ISS) of 16 or more admitted to our level 1 trauma center between January 2008 and December 2015. The cohort was stratified into two groups (age < 70 and ≥ 70 years). One-to-one matching was performed based on gender, ISS, mechanism of injury (penetrating/blunt), Glasgow coma scale (GCS), base excess, and the presence of coagulopathy (international normalized ratio (INR) ≥ 1.4). Outcome was compared using the paired t-test and McNemar-test. A total of 1457 patients were identified. There were 1022 male (70%) and 435 female patients. Three hundred and sixty-four patients (24%) were older than 70 years. Matching resulted in 57 pairs. Mortality as well as length-of-stay were comparable between geriatric and non-geriatric polytraumatized patients. Complication rate (34% vs. 56%, p = 0.031) was significantly higher in geriatric patients. This indicates the possibility of similar outcomes in geriatric polytraumatized patients receiving optimal care.
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Affiliation(s)
- Kai O. Jensen
- Department of Trauma, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.L.); (K.S.); (H.P.S.); (C.P.); (C.H.); (H.C.P.); (V.N.)
- Correspondence: ; Tel.: +41-442551111; Fax: +41-442554466
| | - Maximilian Lempert
- Department of Trauma, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.L.); (K.S.); (H.P.S.); (C.P.); (C.H.); (H.C.P.); (V.N.)
| | - Kai Sprengel
- Department of Trauma, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.L.); (K.S.); (H.P.S.); (C.P.); (C.H.); (H.C.P.); (V.N.)
| | - Hans P. Simmen
- Department of Trauma, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.L.); (K.S.); (H.P.S.); (C.P.); (C.H.); (H.C.P.); (V.N.)
| | - Carina Pothmann
- Department of Trauma, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.L.); (K.S.); (H.P.S.); (C.P.); (C.H.); (H.C.P.); (V.N.)
| | - Mathias Schlögl
- University Clinic for Acute Geriatric Care, City Hospital Waid, 8037 Zurich, Switzerland;
| | - Heike A. Bischoff-Ferrari
- Department of Geriatrics and Ageing Research, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Christian Hierholzer
- Department of Trauma, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.L.); (K.S.); (H.P.S.); (C.P.); (C.H.); (H.C.P.); (V.N.)
| | - Hans C. Pape
- Department of Trauma, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.L.); (K.S.); (H.P.S.); (C.P.); (C.H.); (H.C.P.); (V.N.)
| | - Valentin Neuhaus
- Department of Trauma, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.L.); (K.S.); (H.P.S.); (C.P.); (C.H.); (H.C.P.); (V.N.)
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Horst K, Höfler J, Martin L, Greven J, Schürholz T, Simon TP, Marx G, Hildebrand F. Geriatric Polytrauma-Cardiovascular and Immunologic Response in a Murine Two-Hit Model of Trauma. J Surg Res 2019; 241:87-94. [PMID: 31018170 DOI: 10.1016/j.jss.2019.03.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/07/2019] [Accepted: 03/22/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aims of the present study were to establish a clinically relevant two-hit model with trauma/hemorrhage followed by sepsis in older mice and investigate age-dependent cardiovascular and immunologic specificities under these conditions. MATERIALS AND METHODS In aged mice (12, 18, and 24 mo old), a femur fracture followed by hemorrhage was induced. After resuscitation, animals were monitored for 72 h before sepsis was induced. Vital signs were monitored during shock. Systemic interleukin (IL)-6 levels were measured daily. Expression of sarcoplasmic or endoplasmic reticulum calcium ATPase (SERCA) and IL-6 receptor were analyzed in heart, lung, and liver tissues. RESULTS After induction of shock, mean arterial pressure decreased significantly in all groups (12 mo, P < 0.001; 18 mo, P < 0.001; 24 mo, P = 0.013). Compared with younger animals, 24-mo old mice were not able to adequately compensate for hypovolemia by an increase of heart rate (P = 0.711). Expression of SERCA2 (P = 0.002) and IL-6 receptor on myocytes (P = 0.037), lung (P = 0.005), and liver (P = 0.009) tissues were also lowest in this group. Systemic IL-6 values showed the most distinct posttraumatic response in 24-mo-old mice (P = 0.016). Survival rate decreased significantly with increased age (P = 0.005). CONCLUSIONS The increased mortality rate in older animals was associated with a limited compensatory physiological response and a more distinct immunologic reaction after trauma and sepsis. A decreased SERCA2 expression and missing feedback loops due to a reduced density of organ bound immune receptors might represent possible explanations for the observed age-dependent differences.
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Affiliation(s)
- Klemens Horst
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany.
| | - Johannes Höfler
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Lukas Martin
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany
| | - Johannes Greven
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Tobias Schürholz
- Department of Anaesthesia and Intensive Care, University of Rostock, Rostock, Germany
| | - Tim P Simon
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
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Rommens PM. Paradigm shift in geriatric fracture treatment. Eur J Trauma Emerg Surg 2019; 45:181-189. [PMID: 30725152 DOI: 10.1007/s00068-019-01080-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/30/2019] [Indexed: 01/16/2023]
Abstract
The number of geriatric patients is increasing. These patients exhibit specific characteristics, which influence the type of fracture care. Many patients have comorbidities, which make them more vulnerable to surgical procedures. The soft tissue envelope around the fracture often is compromised due to pre-existing diseases such as diabetes, chronic venous insufficiency or peripheral vascular disease. Bone mineral density has decreased, which enhances the risk of implant loosening. The goals of treatment differ from those, which are valid for younger adults. Primary goal is preserving independency of the elderly patient in his activities of daily life. Advantages and drawbacks of surgical procedures have to be balanced with those of conservative treatment. Fractures of the lower extremities will more often need surgical treatment than fractures of the upper extremities. Patient´s autonomy is best obtained by creating high stability in the fracture plane, which enables motion and weight-bearing. Second priority is prevention of general and local post-operative complications by the use of less invasive surgical procedures. Restoring anatomy and optimal function are less important goals. The implants, which are used, are inserted through small incisions, placed deep under the skin and use long anatomic or osseous corridors. Intramedullary devices have important advantages. This paradigm shift takes the special challenges and requirements of geriatric patients into account.
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Affiliation(s)
- Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg-University Mainz, Mainz, Germany.
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Abstract
Although the field of geriatric trauma is – ironically – young, care for the elderly trauma patient is increasingly recognised as an important challenge, considering the worldwide trend towards increasing longevity. Increasing age is associated with physiological changes and resulting comorbidities that present multiple challenges to the treating physician. Even though polytrauma is less likely with increasing age, lower-energy trauma can also result in life-threatening injuries due to the reduced physiological reserve. Mechanisms of injury and resulting injury patterns are markedly changed in the elderly population and new management strategies are needed. From initial triage to long-term rehabilitation, these patients require care that differs from the everyday standard. In the current review, the special requirements of this increasing patient population are reviewed and management options discussed. With the increase in orthogeriatrics as a speciality, the current status quo will almost certainly shift towards a more tailored treatment approach for the elderly patient. Further research expanding our current knowledge is needed to reduce the high morbidity and mortality rate.
Cite this article: Braun BJ, Holstein J, Fritz T, Veith NT, Herath S, Mörsdorf P, Pohlemann T. Polytrauma in the elderly: a review. EFORT Open Rev 2016;1:146-151. DOI: 10.1302/2058-5241.1.160002.
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Affiliation(s)
- Benedikt Johannes Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Jörg Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Tobias Fritz
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Nils Thomas Veith
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Steven Herath
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Philipp Mörsdorf
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
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Nielson C, Wingett D. Intensive care and invasive ventilation in the elderly patient, implications of chronic lung disease and comorbidities. Chron Respir Dis 2016; 1:43-54. [PMID: 16281668 DOI: 10.1191/1479972304cd012rs] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims: Elderly patients have an increasing prevalence of illness that requires consideration of critical care and invasive ventilatory support. Although critical care of even the very elderly can provide value, with increasing age the potential risks of treatment and diminishing returns with respect to quality and quantity of life result in a need for careful evaluation. Variable combinations of impaired organ function, active disease and residual pathology from past disease and injury all affect critical care, with the consequence that the elderly are a very heterogeneous population. Recognizing that critical care is a limited resource, it is important to identify patients who may be at increased risk or least likely to benefit from treatment. Patients with functional impairments, nutritional deficiencies and multiple comorbidities may be at highest risk of poor outcomes. Those with very severe disease, extreme age and requirements for prolonged ventilatory support have high in-hospital mortality. Functional impairments, comorbidities and severity of illness are usually more important considerations than chronologic age. The objective of this review is to identify how common problems of the elderly affect critical care and decisions concerning use of invasive ventilatory support.
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Bala M, Kashuk JL, Willner D, Kaluzhni D, Bdolah-Abram T, Almogy G. Looking beyond discharge: clinical variables at trauma admission predict long term survival in the older severely injured patient. World J Emerg Surg 2014; 9:10. [PMID: 24450423 PMCID: PMC3933040 DOI: 10.1186/1749-7922-9-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 01/19/2014] [Indexed: 11/23/2022] Open
Abstract
Background Long term follow up is difficult to obtain in most trauma settings, these data are essential for assessing outcomes in the older (≥60) patient. We hypothesized that clinical data obtained during initial hospital stay could accurately predict long term survival. Study design Using our trauma registry and hospital database, we reviewed all trauma admissions (age ≥60, ISS > 15) to our Level 1 center over the most recent 7 years. Mechanism of injury, co-morbidities, ICU admission, and ultimate disposition were assessed for 2-7 years post-discharge. Primary outcome was defined as long term survival to the end of the last year of the study. Results Of 342 patients discharged following initial admission, mean age was 76.2 ± 9.7, and ISS was 21.5 ± 6.9. 119 patients (34.8%) died (mean follow up 18.8 months; range 1.1-66.2 months). For 233 survivors, mean follow-up was 50.2 months (range 24.8-83.8 months). Univariate analysis disclosed post-discharge mortality was associated with age (80.1 ± 9.64 vs. 74.2 ± 9.07), mean number of co-morbidities (1.6 ± 1.1 vs. 1.0 ± 1.2), fall as a mechanism, lower GCS upon arrival (11.85 ± 4.21 vs. 13.73 ± 2.89), intubation at the scene and discharge to an assisted living facility (p < 0.001 for all). Cox regression analysis hazard ratio showed that independent predictors of mortality on long term follow-up included: older age, fall as mechanism, lower GCS at admission and discharge to assisted living facility (all = p < 0.0001). Conclusions Nearly two-thirds of patients ≥60 who were severely injured survived >4 years following discharge; furthermore, admission data, including younger age, injury mechanism other than falls, higher GCS and home discharge predicted a favorable long term outcome. These findings suggest that common clinical data at initial admission can predict long term survival in the older trauma patient.
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Affiliation(s)
- Miklosh Bala
- Department of Surgery and Shock Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Vogel JA, Ginde AA, Lowenstein SR, Betz ME. Emergency department visits by older adults for motor vehicle collisions. West J Emerg Med 2014; 14:576-81. [PMID: 24381674 PMCID: PMC3876297 DOI: 10.5811/westjem.2013.2.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 10/29/2012] [Accepted: 02/22/2013] [Indexed: 11/14/2022] Open
Abstract
Introduction: To describe the epidemiology and characteristics of emergency department (ED) visits by older adults for motor vehicle collisions (MVC) in the United States (U.S.). Methods: We analyzed ED visits for MVCs using data from the 2003–2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Using U.S. Census data, we calculated annual incidence rates of driver or passenger MVC-related ED visits and examined visit characteristics, including triage acuity, tests performed and hospital admission or discharge. We compared older (65+ years) and younger (18–64 years) MVC patients and calculated odds ratios (OR) and 95% confidence intervals (CIs) to measure the strength of associations between age group and various visit characteristics. Multivariable logistic regression was used to identify independent predictors of admissions for MVC-related injuries among older adults. Results: From 2003–2007, there were an average of 237,000 annual ED visits by older adults for MVCs. The annual ED visit rate for MVCs was 6.4 (95% CI 4.6–8.3) visits per 1,000 for older adults and 16.4 (95% CI 14.0–18.8) visits per 1,000 for younger adults. Compared to younger MVC patients, after adjustment for gender, race and ethnicity, older MVC patients were more likely to have at least one imaging study performed (OR 3.69, 95% CI 1.46–9.36). Older MVC patients were not significantly more likely to arrive by ambulance (OR 1.47; 95% CI 0.76–2.86), have a high triage acuity (OR 1.56; 95% CI 0.77–3.14), or to have a diagnosis of a head, spinal cord or torso injury (OR 0.97; 95% CI 0.42–2.23) as compared to younger MVC patients after adjustment for gender, race and ethnicity. Overall, 14.5% (95% CI 9.8–19.2) of older MVC patients and 6.1% (95% CI 4.8–7.5) of younger MVC patients were admitted to the hospital. There was also a non-statistically significant trend toward hospital admission for older versus younger MVC patients (OR 1.78; 95% CI 0.71–4.43), and admission to the ICU if hospitalized (OR 6.9, 95% CI 0.9–51.9), after adjustment for gender, race, ethnicity, and injury acuity. Markers of injury acuity studied included EMS arrival, high triage acuity category, ED imaging, and diagnosis of a head, spinal cord or internal injury. Conclusion: Although ED visits after MVC for older adults are less common per capita, older adults are more commonly admitted to the hospital and ICU. Older MVC victims require significant ED resources in terms of diagnostic imaging as compared to younger MVC patients. As the U.S. population ages, and as older adults continue to drive, EDs will have to allocate appropriate resources and develop diagnostic and treatment protocols to care for the increased volume of older adult MVC victims.
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Affiliation(s)
- Jody A Vogel
- Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado ; University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Adit A Ginde
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Steven R Lowenstein
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Marian E Betz
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
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Bala M, Willner D, Klauzni D, Bdolah-Abram T, Rivkind AI, Gazala MA, Elazary R, Almogy G. Pre-hospital and admission parameters predict in-hospital mortality among patients 60 years and older following severe trauma. Scand J Trauma Resusc Emerg Med 2013; 21:91. [PMID: 24360246 PMCID: PMC3878042 DOI: 10.1186/1757-7241-21-91] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/03/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Gidon Almogy
- Department of Surgery and Trauma Unit, Hadassah University Hospital, Ein Kerem, pob 12000, Jerusalem, 91120, Israel.
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Herscovici D, Scaduto JM. Management of high-energy foot and ankle injuries in the geriatric population. Geriatr Orthop Surg Rehabil 2013; 3:33-44. [PMID: 23569695 DOI: 10.1177/2151458511436112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
By the year 2035 almost 20% of the US population of 389 million people will be 65 years and older. What this group has, compared with aged populations in the past, is better health, more mobility, and more active lifestyles. From January 1989 through December 2010, a total of 494 elderly patients with 536 foot and ankle injuries were identified. Within this group, 237 (48%) patients with 294 injuries were sustained as a result of a high-energy mechanism. These mechanisms consisted of 170 motor vehicle accidents, 30 as a result of high (not ground level) energy falls, 2 from industrial accidents, and 35 classified as other, which included sports, blunt trauma, bicycle, airplane or boating accidents, crush injuries, and injuries resulting from a lawn mower. The injuries produced were 17 metatarsal fractures, 9 Lisfranc injuries, 10 midfoot (navicular, cuneiform, or cuboid) fractures, 23 talus fractures, 63 calcaneal fractures, 73 unimalleolar, bimalleolar, or trimalleolar ankle fractures, 45 pilon fractures, and 3 pure dislocations of the foot or ankle. Overall, 243 (83%) of these injuries underwent surgical fixation and data have shown that when surgery is used to manage high-energy injuries of the foot and ankle in the elderly individuals, the complications and outcomes are similar to those seen in younger patients. Therefore, the decision for surgical intervention for high-energy injuries of the foot and ankle should be based primarily on the injury pattern and not solely on the age of the patient.
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Abstract
The volume of geriatric trauma patients is expected to increase significantly in coming years. Recognition of severe injuries may be delayed because they are less likely to mount classic symptoms of hemodynamic instability. Head injuries of any severity may place geriatric patients at increased risk of mortality, but there are currently no geriatric-specific treatment recommendations that differ from usual adult guidelines. Our understanding of best practices in geriatric trauma and anesthesia care continues to expand, as it does in all other areas of medicine.
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Affiliation(s)
- Shawn E Banks
- Ryder Trauma Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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13
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Polytrauma in the elderly: specific considerations and current concepts of management. Eur J Trauma Emerg Surg 2011; 37:539-48. [DOI: 10.1007/s00068-011-0137-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/26/2011] [Indexed: 11/26/2022]
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Epidemiology of Cranio-Cerebral Injuries in Emergency Medical Services Practice. POLISH JOURNAL OF SURGERY 2011; 83:646-51. [DOI: 10.2478/v10035-011-0103-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Deakin CD. Chronic illness masquerading as acute injury in pre-hospital care. Resuscitation 2007; 76:465-7. [PMID: 17889421 DOI: 10.1016/j.resuscitation.2007.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 07/31/2007] [Accepted: 08/03/2007] [Indexed: 10/22/2022]
Abstract
Clinical diagnosis in pre-hospital care is challenging. It aims to identify life-threatening pathology that requires immediate treatment prior to evacuation to hospital. This case report present two elderly patients injured in a road traffic accident who presented with signs consistent with acute life-threatening pathology. Subsequent investigations in hospital revealed that in both patients, the underlying pathology was secondary to chronic malignancy and not as a result of any injury sustained during the accident. The importance of past medical history and the incidence of co-morbidity in relation to pre-hospital care are discussed.
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Affiliation(s)
- Charles D Deakin
- South Central Ambulance Service NHS Trust, Highcroft, Romsey Road, Winchester SO22 5DH, UK.
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Scheetz LJ, Zhang J, Kolassa JE. Using crash scene variables to predict the need for trauma center care in older persons. Res Nurs Health 2007; 30:399-412. [PMID: 17654535 DOI: 10.1002/nur.20203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Current trauma triage protocols lack sensitivity to occult injuries in older persons, resulting in unacceptable undertriage rates. We identified crash scene information that could be used by emergency personnel to identify the need for trauma center care in older persons injured in motor vehicle crashes. Crash records of 7,883 persons 65 years and older were explored using classification and regression trees (CART) analysis. CART analysis of 26 crash scene variables resulted in two classification trees from which triage decision rules were stated for persons with severe and moderate injuries. Sensitivity and specificity of the rules were 95.15% and 76.47% for severe injury and 83.1% and 81.5% for moderate injury.
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Affiliation(s)
- Linda J Scheetz
- College of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
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18
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Lewis MC, Abouelenin K, Paniagua M. Geriatric trauma: special considerations in the anesthetic management of the injured elderly patient. Anesthesiol Clin 2007; 25:75-90, ix. [PMID: 17400157 DOI: 10.1016/j.atc.2006.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Modern society is characterized as having an ever enlarging population of older adults. There are more elderly patients, and the average age of this group is increasing. The anesthetic management of surgery for the elderly trauma victim is more complicated than in younger adults. Evaluation of the physiologic status of the geriatric patient should take into account the variability of the changes associated with advancing age. Care of the injured elderly patient requires thorough preoperative assessment and planning and the involvement of a multidisciplinary clinical team knowledgeable about and interested in the management of the elderly surgical patient.
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Affiliation(s)
- Michael C Lewis
- Department of Anesthesiology, Miller School of Medicine at the University of Miami, Miami, FL 33101, USA.
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Bacchetta MD, Eachempati SR, Fins JJ, Hydo L, Barie PS. Factors influencing DNR decision-making in a surgical ICU. J Am Coll Surg 2006; 202:995-1000. [PMID: 16735215 DOI: 10.1016/j.jamcollsurg.2006.02.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 02/09/2006] [Accepted: 02/20/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND End-of-life decisions in the surgical ICU can be complicated by the unique characteristics of perioperative illness and the focus on life-extending interventions. We sought to determine whether illness severity correlated with the presence of DNR order in critically ill surgical patients. STUDY DESIGN All surgical ICU patients who were given a DNR order from May 1, 1991 to May 31, 1998 were identified. Demographic data for all patients were collected prospectively. Patients who died without a DNR order were compared with patients with DNR orders. Variables in the analysis included date of DNR order, age, ICU, and hospital lengths of stay, APACHE II and III scores and maximum multiple organ dysfunction scores, past medical history, and mortality. ANOVA, multivariate ANOVA, and chi-square statistical tests were used to analyze the data, with p </= 0.05 used to reject the null hypothesis. RESULTS Mortality for DNR patients was 84.7%. Multiple organ dysfunction syndrome was ubiquitous in this group of patients. There were no differences between DNR and no-DNR groups on the basis of age or APACHE III score or multiple organ dysfunction score. ICU lengths of stay were substantially higher in the patients made DNR, 1.8 +/- 0.1 versus 1.0 +/- 0.1, p = 0.0001, and 16.9 +/- 0.2 versus 12.1 +/- 1.2, p = 0.011, respectively. Multivariate ANOVA revealed that only past medical history predicted a DNR order. CONCLUSIONS Although acuity of illness and organ dysfunction consistently predicted mortality in critically ill patient populations, only elements of the past medical history were positively associated with a DNR order in critically ill surgical patients. Additional prospective studies need to be performed to determine the relative influences of physiologic, demographic, and sociologic factors on the creation of DNR orders in critically ill surgical patients.
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Affiliation(s)
- Matthew D Bacchetta
- Department of Surgery, Weill Medical College of Cornell University, New York, NY, USA
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21
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Abstract
PURPOSE To analyze the research published in peer-reviewed journals between 1996 and 2005 about factors affecting the physical outcomes of older adults after serious traumatic injury. ORGANIZING CONSTRUCT Twenty-seven primary research studies published in the last 10 years pertained to in-hospital and long-term outcomes of serious injury among older adults. Research specific to isolated hip injury, traumatic brain injury, and burn trauma was excluded. METHODS An integrative review of research published between January 1996 and January 2005 was carried out to examine the relationship between older age and outcome from severe injury. MEDLINE, BIOSIS previews, CINAHL, and PsycINFO databases were searched using the MeSH terms: injury, serious injury, trauma and multiple trauma, and crossed with type, severity, medical/surgical management, complication, outcome, mortality, morbidity, survival, disability, quality of life, functional status, functional recovery, function, and placement. FINDINGS Older adults in these studies had higher short- and long-term mortality than did younger adults. The relationship between older age and poorer outcome persisted when adjusting for injury severity, number of injuries, comorbidities, and complications. At the same time, injury severity, number of injuries, complications, and gender each independently correlated with increased mortality among older adults. The body of research is limited by overreliance on retrospective data and heterogeneity in definitional criteria for the older adult population. CONCLUSIONS Additional research is needed to clarify the contributory effect of variables such as psychosocial sequelae and physiologic resilience on injury outcome. The field of geriatric trauma would benefit from further population-based prospective investigation of the determinants of injury outcome in older adults in order to guide interventions and acute care treatment.
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Affiliation(s)
- Sara F Jacoby
- University of Pennsylvania School of Nursing, 420 Guardian Drive, Philadelphia, PA 19104-6096, USA
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Rellos K, Falagas ME, Vardakas KZ, Sermaides G, Michalopoulos A. Outcome of critically ill oldest-old patients (aged 90 and older) admitted to the intensive care unit. J Am Geriatr Soc 2006; 54:110-4. [PMID: 16420206 DOI: 10.1111/j.1532-5415.2005.00544.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the outcomes of critically ill oldest-old patients (> or = 90) with those of younger patients. DESIGN Prospective cohort study. SETTING General intensive care unit (ICU) of a tertiary care hospital in Athens, Greece. PARTICIPANTS The oldest-old and younger patients. MEASUREMENTS In-hospital and ICU mortality and stay, demographics, comorbidity, and complications. RESULTS Of 5,505 consecutive patients admitted to the ICU, 60 (1.1%) were in the oldest-old group (aged 90-98). Their mean length of ICU and hospital stay+/-standard deviation was 5.3+/-6.8 and 23.3+/-35.7 days, respectively. ICU mortality was 20%. Total in-hospital mortality was 40%, compared with 8.9% (P=.001) in younger patients. Acute Physiology and Chronic Health Evaluation II score was independently associated with in-hospital mortality (odds ratio=1.18, 95% confidence interval=1.05-1.33). Of 24 oldest-old patients who died, 22 (91.7%) died in the ICU or in the ward within 30 days after ICU discharge. CONCLUSION All-cause in-hospital mortality was higher in the oldest-old group than in younger patients, but the mortality of this cohort of patients did not seem to reach a figure that would make physicians, relatives, and healthcare administrators decide against ICU care in this population.
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Scheetz LJ. Differences in survival, length of stay, and discharge disposition of older trauma patients admitted to trauma centers and nontrauma center hospitals. J Nurs Scholarsh 2006; 37:361-6. [PMID: 16396410 DOI: 10.1111/j.1547-5069.2005.00062.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To examine the relationship of level of care (trauma center [TC], nontrauma center [NTC] hospitals) on three outcomes: survival, length of stay, and discharge disposition. DESIGN Retrospective secondary analysis of a subset of data (1,418 patients age 65 to 99 years) from a large statewide study in which the purpose was to compare admission patterns (TCs and NTCs) of motor vehicle (MV) trauma patients according to age and sex. The New Jersey UB-92 Patient Discharge Data for 2000 were used in this analysis. METHODS Demographic and clinical variables were compared using descriptive data, independent samples t tests, Pearson chi square, and Mann-Whitney U analyses. Logistic regression and multiple regression analyses were performed to examine relationships between level of care and three outcome variables, survival, length of stay, and discharge disposition, while controlling for age and severity of injury. RESULTS NTC admission was the only predictor of survival and discharge to home, but injury severity was the strongest predictor of length of stay, followed by NTC care. The odds of survival and discharge home decreased slightly as age and injury severity increased. CONCLUSIONS This analysis indicated preliminary evidence that level of care influences survival, length of stay, and discharge disposition. Studies are warranted for researchers to examine the influence of postinjury variables, including complications, stress reaction, and depression on outcomes.
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Affiliation(s)
- Linda J Scheetz
- Rutgers, The State University of New Jersey, College of Nursing, Newark, NJ 07102, USA.
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Scheetz LJ. Relationship of age, injury severity, injury type, comorbid conditions, level of care, and survival among older motor vehicle trauma patients. Res Nurs Health 2005; 28:198-209. [PMID: 15884027 DOI: 10.1002/nur.20075] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this secondary data analysis was to compare age, injury severity, injury types, selected comorbidities, level of care (at trauma center [TC] and non-trauma center [NTC] hospitals), and survival among older motor vehicle trauma patients (N = 1,478). Patients admitted to both levels of care had similar comorbid conditions. TC patients had a higher injury severity, whereas NTC patients had a greater proportion of soft tissue injuries. Results of logistic regression analyses subsequent to group comparisons revealed that higher injury severity was associated with TC admission. The likelihood of TC admission of severely injured patients decreased in the presence of spinal, internal, and head injuries. Internal injuries, liver, renal, and cardiovascular diseases were associated with non-survival while hypertension was associated with survival. Special attention is needed when triaging older trauma patients because their injuries may be covert, thus putting them at risk for admission to a level of care that may be inappropriate given the extent of their injuries.
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Affiliation(s)
- Linda J Scheetz
- Rutgers, The State University of New Jersey, Newark, NJ, USA
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Abstract
Each year thousands of older adults will suffer trauma injuries. Geriatric patients who sustain serious injuries are at risk for increased morbidity and mortality. Preexisting medical conditions can dramatically impact every aspect of care in older patients. As a direct response to the stress of injury, reserve functioning can be put to the test. Vital signs may initially appear normal. However, compensatory mechanisms in older individuals may not be predictable in response to physiological needs. Perianesthesia nurses caring for older trauma patients should be familiar with the anatomical and physiological changes of aging, and have an awareness of the original mechanism of injury, coupled with the surgical procedure and anesthesia agents. Astute nursing assessments using critical thinking skills, together with effective nursing interventions, provide the framework for understanding and managing geriatric trauma patients in the perianesthesia care continuum.
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Kieninger AN, Bair HA, Bendick PJ, Howells GA. Epidural versus intravenous pain control in elderly patients with rib fractures. Am J Surg 2005; 189:327-30. [PMID: 15792761 DOI: 10.1016/j.amjsurg.2004.11.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2004] [Revised: 11/24/2004] [Accepted: 11/24/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Epidural catheters are used in older patients with rib fractures to improve outcome. We reviewed the efficacy of epidural analgesia (EA) compared with intravenous narcotics (IVN) in this population. METHODS Rib fracture patients >55 years old admitted to our level I trauma center from 1999 through 2002 were reviewed for demographics, Injury Severity Score (ISS), Abbreviated Injury Score for chest, length of stay, cardiopulmonary comorbidities, complications, and type of analgesia. RESULTS There were 187 patients: 72 men and 115 women. The mean age was 77 years. For ISS <9, length of stay for EA patients was 12 +/- 5 days versus 5 +/- 4 days for IVN patients (P < 0.001). Complications occurred in 9 of 10 EA patients versus 21 of 52 IVN patients (P < 0.001). No difference was noted in length of stay for patients with ISS > or =9. Complications in the high ISS group occurred in 29 of 43 EA patients versus 37 of 82 IVN patients (P <0.05). Stratification of patients based on low versus high Abbreviated Injury Score for chest yielded similar results. CONCLUSIONS EA is associated with prolonged length of stay and increased complications in elderly patients, particularly those with less significant injuries, regardless of cardiopulmonary comorbidities. EA for elderly patients with rib fractures should be prospectively re-evaluated.
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Affiliation(s)
- Alicia N Kieninger
- Division of Trauma Surgery, William Beaumont Hospital, 3601 W. Thirteen Mile Rd., Royal Oak, MI 48073, USA
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Affiliation(s)
- Reuven Rabinovici
- Section of Trauma and Surgical Critical Care, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA
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Scheetz LJ. Effectiveness of prehospital trauma triage guidelines for the identification of major trauma in elderly motor vehicle crash victims. J Emerg Nurs 2003; 29:109-15. [PMID: 12660691 DOI: 10.1067/men.2003.59] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Undertriage of older trauma victims has been a persistent and serious problem. Because of physiologic changes and pre-existing disease, blunt trauma in older persons is often covert. Prehospital trauma triage guidelines developed for use with a general adult population may not be sensitive enough to detect covert injuries in elderly trauma patients. This study examined the sensitivity and specificity of one state's prehospital trauma triage guidelines for adults, with a particular focus on the triage of elderly persons. METHODS This retrospective study used patient discharge data to examine the sensitivity (a measure of undertriage) and specificity (a measure of overtriage) of the adult prehospital trauma triage guidelines in 3 counties with level I trauma centers. Sensitivity and specificity of young and middle-aged adults was compared with that of older adults. RESULTS Undertriage was 8% for young and middle-aged men, 12% for young and middle-aged women, 18% for older men, and 15% for older women. Overtriage was present in all age groups, indicating that many motor vehicle crash victims who were admitted to trauma centers could have been admitted to nontrauma center hospitals. DISCUSSION Low sensitivity and specificity of trauma triage guidelines results in undertriage and overtriage. These guidelines should include age as a decision point to avoid placing older persons at risk for undertriage. Although some degree of overtriage is unavoidable without increasing undertriage, efforts should be made to minimize this costly occurrence.
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Affiliation(s)
- Linda J Scheetz
- College of Nursing, Rutgers, The State University of New Jersey, 180 University Avenue, Newark, NJ 07102-1897, USA.
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Gallagher SF, Williams B, Gomez C, DesJardins C, Swan S, Durham RM, Flint LM. The role of cardiac morbidity in short- and long-term mortality in injured older patients who survive initial resuscitation. Am J Surg 2003; 185:131-4. [PMID: 12559442 DOI: 10.1016/s0002-9610(02)01208-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Elderly patients are an increasingly larger group of injured trauma care patients. Comorbidities influence outcome. Little is known of short- and long-term mortality in the elderly who survive initial resuscitation. METHODS Short- and long-term mortality was retrospectively analyzed in 363 consecutively injured patients (Injury severity score >15) surviving more than 3 days after admission to a level 1 trauma center (including 197 patients >60 years). Cardiac morbidity was the focus. RESULTS Survival to hospital discharge was similar comparing older patients with the entire group. Mortality increased incrementally with age. In older patients, cardiac morbidity was observed in 28% (fatal in 7); 2-year mortality was 36% (older group) and 60% (patients sustaining cardiac complications). Most elderly (80%) were discharged to long-term care. CONCLUSIONS Elderly who survive initial resuscitation are as likely to survive to discharge as younger patients, but long-term survival is significantly lower as age increases. Cardiac morbidity is associated with higher long-term mortality. Most elderly are discharged to long-term care.
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Affiliation(s)
- Scott F Gallagher
- Department of Surgery, University of South Florida College of Medicine, and the Regional Trauma Center at Tampa General Hospital, Tampa, FL, USA
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O'brien DP, Luchette FA, Pereira SJ, Lim E, Seeskin CS, James L, Miller S, Davis K, Hurst JM, Johannigman JA, Frame SB. Pelvic fracture in the elderly is associated with increased mortality. Surgery 2002; 132:710-4; discussion 714-5. [PMID: 12407356 DOI: 10.1067/msy.2002.127690] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The elderly population is currently the fastest growing sector in America. The purpose of this study was to examine the age-related outcome in patients after blunt pelvic injury. METHODS All patients admitted with a pelvic fracture during a 5-year period were identified from the trauma registry. Data retrieval included: demographics, shock (BP < 90 mm Hg) on admission, injury severity score (ISS), abbreviated injury score (AIS) for head, chest, and abdomen, intensive care unit (ICU) length of stay (LOS), hospital LOS, and mortality. All pelvic fracture patterns were classified. Patient data were then stratified by age for comparison: young (< 55 years) and elderly (> or = 55 years). Statistical analysis was performed using the Student t test, Wilcoxon rank-sum test, multiple logistic regression analysis, and chi-square test with significance set at P <.05. RESULTS Three hundred five patients sustained a pelvic fracture (young [n = 248, 81.3%]; elderly [n = 57, 18.7%]). The only predictor of mortality was age. The 2 groups differed by gender (elderly = 54.4% females; young = 62.5% males) but not frequency of shock, ISS, or AIS for head, chest, and abdomen. Motor vehicle collision was the most common mechanism of injury (elderly = 68.4%; young = 73.8%). Lateral compression was the most common fracture pattern in both groups (elderly = 54.4%; young = 45.6%). There was no difference in transfusion (elderly = 2.5 +/- 0.7 vs young = 2.0 +/- 0.3; ns) but the elderly group was more frequently admitted to the ICU (elderly = 61.4% vs young = 46.8%; P =.065). Significantly more of the elderly group had a diagnosis of cardiovascular disease (43.9% vs 10.1%, P <.001) and diabetes mellitus (10.5% vs 2.4%, P <.014). Mortality was significantly greater in the elderly group (12.3% vs 2.3%). CONCLUSION Elderly patients sustaining a pelvic fracture were more likely to have a lateral compression fracture pattern, longer hospital LOS, and die despite aggressive resuscitation. This difference in outcome should help trauma surgeons recognize that the elderly patient sustaining a pelvic fracture is at increased risk of death.
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Affiliation(s)
- David P O'brien
- Division of Trauma and Critical Care, Departments of Surgery and Orthopedics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Henry SM, Pollak AN, Jones AL, Boswell S, Scalea TM. Pelvic fracture in geriatric patients: a distinct clinical entity. THE JOURNAL OF TRAUMA 2002; 53:15-20. [PMID: 12131383 DOI: 10.1097/00005373-200207000-00004] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to describe differences in demographics, injury pattern, transfusion needs, and outcome of pelvic fractures in older versus younger patients. METHODS This was a retrospective registry review of all patients with pelvic fractures admitted directly from the scene between January 1998 and December 1999. RESULTS We cared for 234 patients with pelvic fractures during the study period. Mean age was 37.2 years, 51% were men, and mean Injury Severity Score (ISS) was 19. Overall mortality was 9%. Eighty-three percent were under the age of 55 years and 17% were older than 55 years. Severe pelvic fractures (AP3, LC3) were more common in young patients (p < 0.05). Admitting systolic blood pressure was lower and heart rate higher, although ISS was not different between the two age groups. Older patients were 2.8 times as likely to undergo transfusion (p < 0.005), and those undergoing transfusion required more blood (median, 7.5 units vs. 5 units). Older patients underwent angiography more frequently and were significantly more likely to die in the hospital even after adjusting for ISS (p < 0.005). This was most marked with ISS 15 to 25. Lateral compression (LC) fractures occurred 4.6 times more frequently in older patients than anteroposterior (AP) compression, and 8.2 times more frequently in those older patients undergoing transfusion as compared with AP compression. Ninety-eight percent of LC fractures in older patients were minor (LC1,2). However, older patients with LC fractures were nearly four times as likely to require blood compared with younger patients. CONCLUSION In older patients, pelvic fractures are more likely to produce hemorrhage and require angiography. Fracture patterns differ in older patients, with LC fractures occurring more frequently, and commonly causing significant blood loss. The outcome of older patients with pelvic fractures is significantly worse than younger patients, particularly with higher injury severity. Recognition of these differences should help clinicians to identify patients at high risk for bleeding and death early, and to refine diagnostic and resuscitation strategies.
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Affiliation(s)
- Sharon M Henry
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Abstract
Pediatric patients are not just "little adults" and elderly patients are not just "old adults." The elderly patient experiences physiologic and anatomic changes that affect all body systems. Providing trauma care for the elderly presents a particular challenge. Muscle atrophy, osteoporosis, and decreased subcutaneous tissue make the elderly patient more prone to a greater severity of injury. Alterations in the cardiovascular and respiratory systems limit the physiologic reserve the elderly need to respond to hypoxia and shock. Preexisting health conditions further complicate the picture. This article highlights some of the important differences in caring for an elderly trauma patient from resuscitation to rehabilitation.
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Affiliation(s)
- Barbara Pudelek
- Department of Trauma and Surgical Critical Care, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA.
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