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Dash J, Andereggen E, Bentellis I, Massalou D. Comparison of adult versus elderly patients with abdominal trauma: A retrospective database analysis. PLoS One 2024; 19:e0309174. [PMID: 39159197 PMCID: PMC11332922 DOI: 10.1371/journal.pone.0309174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/06/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND The growing geriatric population has specific medical characteristics that should be taken into account especially in trauma setting. There is little evidence on management of abdominal trauma in the elderly and this article compares the management and outcomes of younger and older patients in order to highlight fields of improvement. METHOD We conducted a retrospective database analysis from two European university hospitals selecting patients admitted for abdominal injury and extracted the following data: epidemiological data, mechanisms of the trauma, vital signs, blood tests, injuries, applied treatments, trauma scores and outcomes. We compared to different age group (16-64 and 65+ years old) using uni- and multivariable analysis. RESULTS 1181 patients were included for statistical analysis. The main mechanisms of injury in both group were traffic accidents and in the elderly group, falls were more frequent. Both had similar Abbreviated Injury Score except for the thoracic injuries, which was higher in the elderly group. We reported a death rate of 13% in the elderly group and 7% in the younger group. However, multivariable analysis did not report age as an independent predictor of mortality. The management including surgery, blood transfusion and need for intensive care were similar in both groups. CONCLUSION Although elderly patients suffering abdominal trauma have an almost two fold higher mortality, their management is quite similar leading to an important point of improvement in regards to triage and lower threshold for more aggressive management and surveillance. Age itself does not seem to be a reliable predictor of mortality. Introducing a frailty score when taking care of elderly trauma patients could improve the outcomes.
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Affiliation(s)
- Jeremy Dash
- Departement of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Elisabeth Andereggen
- Departement of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Imad Bentellis
- Departement of Urology, University Hospital of Nice, Nice, France
| | - Damien Massalou
- Emergency Surgery Unit, Digestive Surgery, University Hospital of Nice, Nice, France
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Findakly S, Zia A, Kavnoudias H, Mathew J, Varma D, Di Muzio B, Lee R, Moriarty HK, Joseph T, Clements W. The use of whole-body trauma CT should be based on mechanism of injury: A risk analysis of 3920 patients at a tertiary trauma centre. Injury 2023:110828. [PMID: 37225543 DOI: 10.1016/j.injury.2023.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/27/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Mechanism of injury (MOI) plays a significant role in a decision to perform whole-body computed tomography (CT) imaging for trauma patients. Various mechanisms have unique patterns of injury and therefore form an important variable in decision making. METHODS Retrospective cohort study including all patients >18 years old who received a whole-body CT scan between 1 January 2019 and 19 February 2020. The outcomes were divided into CT 'positive' if any internal injuries were detected and CT 'negative' if no internal injuries were detected. The MOI, vital sign parameters, and other relevant clinical examination findings at presentation were recorded. RESULTS 3920 patients met the inclusion criteria, of which 1591 (40.6%) had a positive CT. The most common MOI was fall from standing height (FFSH), accounting for 23.0%, followed by motor vehicle accident (MVA), accounting for 22.4%. Covariates significantly associated with a positive CT included age, MVA >60 km/h, motor bike, bicycle, or pedestrian accident >30 km/h, prolonged extrication >30 min, fall from height above standing, penetrating chest or abdominal injury, as well as hypotension, neurological deficit, or hypoxia on arrival. FFSH was shown to reduce the risk of a positive CT overall, however, sub-analysis of FFSH in patients >65 years showed a significant association with a positive CT (OR 2.34, p < 0.001) compared to <65 years. CONCLUSIONS Pre-arrival information including MOI and vital signs have significant impact on identifying subsequent injuries with CT imaging. In high energy trauma, we should consider the need for whole-body CT based on MOI alone regardless of the clinical examination findings. However, for low-energy trauma, including FFSH, in the absence of clinical examination findings which support an internal injury, a screening whole-body CT is unlikely to yield a positive result, particularly in the age group <65yo.
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Affiliation(s)
- Salam Findakly
- Department of Radiology, Alfred Health, Melbourne, Australia. https://twitter.com/https//twitter.comSalamfindalky
| | - Adil Zia
- Department of Radiology, Alfred Health, Melbourne, Australia. https://twitter.com/https//twitter.comAdilFZia
| | - Helen Kavnoudias
- Department of Radiology, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University, Australia
| | - Joseph Mathew
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia; Department of Trauma, Alfred Health, Melbourne, Australia. https://twitter.com/https//twitter.comtrauma_jm
| | - Dinesh Varma
- Department of Radiology, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University, Australia; National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia
| | - Bruno Di Muzio
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Robin Lee
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Heather K Moriarty
- Department of Radiology, Cork University Hospital, Cork, Ireland. https://twitter.com/https//twitter.comHeatherKateIR
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University, Australia; National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia.
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Breedt DS, Steyn E. Geriatric Trauma in a High-Volume Trauma Centre in Cape Town: How Do We Compare? World J Surg 2022; 46:582-590. [PMID: 34994839 DOI: 10.1007/s00268-021-06416-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Little is known about the injury profile of older persons from low-and-middle-income countries, such as South Africa, where violence is prevalent. This study aimed to identify common mechanisms of injury (MOI), severity, complications, and outcomes in elderly patients admitted to a referral trauma centre in Cape Town. METHODS A retrospective review was performed of all patients ≥60 years presenting at Tygerberg hospital trauma centre over an eight-month period. Descriptive statistics were computed for all variables of interest, and the relationship between the MOI, injury severity score (ISS), complications, and outcomes were assessed. RESULTS Of the total 7,635 trauma cases admitted, patients ≥60 years accounted for 4% (n = 275). The most frequent MOI was low falls (58%). Of these 11% of injuries were intentionally inflicted. Among them 35% of the patients experienced complications. The ISS was positively associated with the number of complications (p < 0.01). The mortality rate was 6.5%. An ISS of ≥10 was associated with increased mortality (p < 0.01). The number of complications was positively associated with mortality (p < 0.01). CONCLUSIONS In contrast to high-income countries (HICs), the cohort of elderly patients admitted to the trauma centre made up a relatively small portion of the total admissions. Compared to HICs, intentionally inflicted injuries and preventable MOI were common in our sample, underscoring the importance of addressing causative factors. Notably, the ISS was strongly associated with the number of complications and an ISS ≥10 was associated with mortality, highlighting the utility of the ISS in identifying elderly trauma patients most at risk of negative outcomes.
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Affiliation(s)
- Danyca Shadé Breedt
- Faculty of Medicine & Health Science, Stellenbosch University, Francie van Zijl Drive, Cape Town, South Africa.
| | - Elmin Steyn
- Division of Surgery, Stellenbosch University & Tygerberg Hospital, Francie van Zijl Drive, Cape Town, South Africa
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A COMPARATIVE ANALYSIS OF ASSOCIATED INJURIES IN THE ELDERLY AND YOUTH FOR FACIAL FRACTURES. J Plast Reconstr Aesthet Surg 2022; 75:1979-1987. [DOI: 10.1016/j.bjps.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/13/2021] [Accepted: 12/19/2021] [Indexed: 11/15/2022]
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Facial fractures in the elderly: epidemiology, clinical characteristics, and management. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01800-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Atinga A, Shekkeris A, Fertleman M, Batrick N, Kashef E, Dick E. Trauma in the elderly patient. Br J Radiol 2018; 91:20170739. [PMID: 29509505 DOI: 10.1259/bjr.20170739] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Major Trauma Centres and Emergency Departments are treating an increasing number of elderly trauma patients in the UK. Elderly patients, defined as those over the age of 65 years, are more susceptible to injury from lesser mechanisms of trauma than younger adults. The number of elderly trauma cases is rising yearly, accounting for >25% of all major trauma nationally. The elderly have different physiological reserves and a different response to trauma due to premorbid frailty, co-existing conditions and prescribed medication. These factors need to be appreciated in trauma triaging, radiological assessment and clinical management. A lower threshold for trauma-call activation is recommended, including a lower threshold for advanced imaging. We will review general principles of trauma in the elderly, outline injury patterns in this age group and illustrate the radiological features per anatomical site, from head to pelvis and the extremities. We advocate using contrast-enhanced computed tomography as the primary diagnostic imaging modality as concern about intravenous contrast agent-induced nephropathy is relatively minor. Prompt investigation and diagnosis leads to timely appropriate treatment, therefore the radiologist can discerningly improve morbidity and mortality in this vulnerable group.
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Affiliation(s)
- Angela Atinga
- 1 Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
| | - Andreas Shekkeris
- 1 Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
| | - Michael Fertleman
- 2 Department of Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
| | - Nicola Batrick
- 3 Department of Emergency Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
| | - Elika Kashef
- 1 Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
| | - Elizabeth Dick
- 1 Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
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Gonsaga RAT, Silva EMD, Brugugnolli ID, Cabral JL, Thomé Neto O. Padrão e necessidades de atendimento pré-hospitalar a idosos. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.13171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As principais doenças que atingem os idosos são as crônico-degenerativas, que somadas às frequentes comorbidades desse grupo, demandam maior preocupação por parte das instituições de saúde e, consequentemente, maior utilização de serviços de alta complexidade. O objetivo do estudo foi descrever os atendimentos de idosos pelo Serviço de Atendimento Móvel de Urgência SAMU no município de Catanduva-SP, com base em registros de atendimentos aos indivíduos com idade superior a 59 anos lá realizados. Foram analisados dados demográficos, sinais vitais, tipos de atendimento segundo gênero, nível de atenção à saúde indicado para resolução da ocorrência, horários das ocorrências e relação entre os grupos etários e ocorrências de clínica médica e traumáticas. Foram atendidos 42.629 pacientes, a maioria do sexo feminino 55%; a média de idade foi de 74,2 anos. Houve significância estatística nos sinais vitais quando comparados os gêneros. As ocorrências de maior frequência foram as classificadas como enfermidades clínicas, seguidas por solicitações sociais e transferências intra-hospitalares. Houve aumento dos agravos agudos clínicos e traumáticos nas faixas etárias de maior idade, e 77,9% dos atendimentos necessitaram de uma unidade fixa de atendimento para continuidade do tratamento. Encontrou-se, ainda, predomínio de atendimento nos horários de vigília dos pacientes. Observam-se maiores taxas de ocorrências com o aumento da faixa etária e utilização mais frequente de atendimento hospitalar terciário pós-ocorrências, fato que caracteriza, de maneira geral, o modelo hospitalocêntrico.
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Abstract
Aging physiology greatly impacts care delivery in the geriatric patient population. Consideration should be given to addressing the patient-specific needs regarding the systemic changes seen in the aging patient. Each major body system presents its own unique challenges to the critical care practitioner, and a comprehensive understanding of these changes is necessary to effectively care for this patient population. This article summarizes these changes and provides key points for the practitioner to consider when caring for the aging patient in the critical care arena.
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Affiliation(s)
- Mandi Walker
- Nursing Education and Research Department, University of Louisville Hospital, 530 South Jackson Street, Louisville, KY 40202, USA.
| | - Mark Spivak
- Nursing Education and Research Department, University of Louisville Hospital, 530 South Jackson Street, Louisville, KY 40202, USA
| | - Mary Sebastian
- Nursing Education and Research Department, University of Louisville Hospital, 530 South Jackson Street, Louisville, KY 40202, USA
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