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Turino FD, Jural LA, da Silva LLA, Magno MB, Maia LC, Risso PA. World trends in publication for maxillofacial and dental trauma in the elderly. Dent Traumatol 2024; 40:333-344. [PMID: 38124460 DOI: 10.1111/edt.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/11/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
Aging may increase the risk of maxillofacial and dentoalveolar trauma (MDT). This review assessed global trends in scientific publications on MDT in the elderly. Six databases were searched. Studies about MDT in the elderly (≥60 years old) were included in two text mining stages (S1 and S2). In S1, all studies with elderly subjects were included, while in S2 only studies in which the elderly were assessed in a separate set of data or in a subanalysis by age groups were included. In S1, relevant data were mined using VantagePoint™ software. In S2, data were descriptively analyzed. There were 2265 studies at S1 and 110 at S2. The publication dates spanned from 1963 to 2023. In S1, the most cited keywords and terms were aged (n = 1872), male (n = 1839), female (n = 1777), "mandible fracture" (n = 460), "orbit fracture" (n = 362), and "maxilla fracture" (n = 118). Thirty authors published 10 or more articles with visible collaboration networks. There was a progressive increase in publications, especially in Europe (n = 150). In S2, most studies were case reports/case series (n = 62). The primary etiology was accidental falls (n = 84), the most affected region was the middle third of the face (n = 65), and dental trauma was rarely reported (n = 15). Cone Beam computed tomography was the most used diagnostic tool (n = 67). Of the 81 articles that addressed therapy, 52 opted for surgical treatment. Although there has been an increase in the number of articles on MDT over the years, studies with the elderly population as a specific study group are still needed. Accidental falls were the most reported etiology, while the middle third of the face and the mandible were the anatomic region and bone most affected, respectively. The high number of case reports indicates the need for improvement in the available scientific evidence about MDT in the elderly.
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Affiliation(s)
- Fabiana Dantas Turino
- Department of Dental Clinic, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucas Alves Jural
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leticia Lopes A da Silva
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciane Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia A Risso
- Department of Dental Clinic, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Molendijk-van Nieuwenhuyzen K, Belt-van Opstal R, Hakvoort L, Dikken J. Exploring geriatric trauma unit experiences through patients' eyes: a qualitative study. BMC Geriatr 2024; 24:476. [PMID: 38816688 PMCID: PMC11140891 DOI: 10.1186/s12877-024-05023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION The surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit's emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization. METHODS This qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed. RESULTS The findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit. CONCLUSION Effective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.
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Affiliation(s)
| | | | | | - Jeroen Dikken
- De Haagse Hogeschool, Faculteit Gezondheid, Voeding & Sport, Johanna Westerdijkplein 75, 2521 EN, The Hague, The Netherlands
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Sarquis LM, Collaço IA, Toderke EL, Fontes HS, Nassif AT, Freitas ACTDE. Epidemiological profile of patients undergoing non-operative management of solid organ injury and associated factors with mortality. Rev Col Bras Cir 2024; 51:e20243734. [PMID: 38808820 PMCID: PMC11185065 DOI: 10.1590/0100-6991e-20243734-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/18/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Trauma primarily affects the economically active population, causing social and economic impact. The non-operative management of solid organ injuries aims to preserve organ function, reducing the morbidity and mortality associated with surgical interventions. The aim of study was to demonstrate the epidemiological profile of patients undergoing non-operative management in a trauma hospital and to evaluate factors associated with mortality in these patients. METHODS This is a historical cohort of patients undergoing non-operative management for solid organ injuries at a Brazilian trauma reference hospital between 2018 and 2022. Included were patients with blunt and penetrating trauma, analyzing epidemiological characteristics, blood transfusion, and association with the need for surgical intervention. RESULTS A total of 365 patients were included in the study. Three hundred and forty-three patients were discharged (93.97%), and the success rate of non-operative treatment was 84.6%. There was an association between mortality and the following associated injuries: hemothorax, sternal fracture, aortic dissection, and traumatic brain injury. There was an association between the need for transfusion and surgical intervention. Thirty-eight patients required some form of surgical intervention. CONCLUSION The profile of patients undergoing non-operative treatment consists of young men who are victims of blunt trauma. Non-operative treatment is safe and has a high success rate.
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Affiliation(s)
- Lucas Mansano Sarquis
- - Universidade Federal do Paraná, Clínica Cirúrgica - Curitiba - PR - Brasil
- - Complexo Hospitalar do Trabalhador, Cirurgia Geral e Cirurgia do Trauma - Curitiba - PR - Brasil
| | - Iwan Augusto Collaço
- - Complexo Hospitalar do Trabalhador, Cirurgia Geral e Cirurgia do Trauma - Curitiba - PR - Brasil
| | | | | | - André Tha Nassif
- - Universidade Federal do Paraná, Clínica Cirúrgica - Curitiba - PR - Brasil
| | - Alexandre Coutinho Teixeira DE Freitas
- - Universidade Federal do Paraná, Clínica Cirúrgica - Curitiba - PR - Brasil
- - Complexo Hospitalar do Trabalhador, Cirurgia Geral e Cirurgia do Trauma - Curitiba - PR - Brasil
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Ramos TMC, da Silva Alves ÁA, Apolinário TA, de Toledo FF, Gomes VE, Barbosa KGN, Sampaio AA, Ferreira RC. Challenges to conducting research on oral health with older adults living in long-term care facilities. BMC Oral Health 2024; 24:422. [PMID: 38580950 PMCID: PMC10998329 DOI: 10.1186/s12903-024-04204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The challenges to conducting oral health studies involving older people in long-term care facilities (LTCFs) must be debated. OBJECTIVE This study aimed to investigate researchers' perceptions and experiences while conducting an epidemiological survey on oral health among older individuals residing in LTCFs. METHODS A qualitative study was conducted involving six researchers who utilized field diaries to record their impressions during data collection through interviews (older individuals (or their proxies), caregivers, and LTCF coordinators) and oral examinations of the older people participants. Additionally, researchers responded to open-ended questions about their experiences. The collected material was subjected to content analysis by two researchers. RESULTS The themes that emerged from the analysis were institutional context, aspects affecting the operationalization of the study, and data collection oriented by the clinical-functional profile of the older people. According to the researchers' perceptions, LTCF coordinators demonstrated concern for the study's benefits for older adults and the preservation of institutional routines during the research process. Caregivers emerged as vital sources of information, guiding researchers in navigating the challenges posed by the physical and mental complexities of the older people participants, necessitating empathy, sensitivity, and attentive listening from the researchers. The organization of materials and a streamlined data collection process proved essential for optimizing time efficiency and reducing stress for participants and researchers. CONCLUSION The researchers recognized the important role played by LTCF coordinators and formal caregivers, underscoring the significance of empathetic methodologies and streamlined data collection processes in mitigating the challenges inherent to research conducted within LTCFs.
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Affiliation(s)
- Thayse Mayra Chaves Ramos
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Álvaro Augusto da Silva Alves
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thais Andrade Apolinário
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Flávia Fonseca de Toledo
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Viviane Elisângela Gomes
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kevan Guilherme Nóbrega Barbosa
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Araújo Sampaio
- Department of Clinical, Pathology and Surgical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Raquel Conceição Ferreira
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Orso D, Furlanis G, Romanelli A, Gheller F, Tecchiolli M, Cominotto F. Risk Factors Analysis for 90-Day Mortality of Adult Patients with Mild Traumatic Brain Injury in an Italian Emergency Department. Geriatrics (Basel) 2024; 9:23. [PMID: 38525740 PMCID: PMC10961819 DOI: 10.3390/geriatrics9020023] [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: 12/11/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose: The most prominent risk factors for mortality after mild traumatic brain injury (TBI) have not been established. This study aimed to establish risk factors related to 90-day mortality after a traumatic event. Methods: A retrospective cohort study on adult patients entering the Emergency Department of the University Hospital of Trieste for mild TBI from 1 January 2020 to 31 December 2020 was conducted. Results: The final population was 1221 patients (median age of 78 years). The 90-day mortality rate was 7% (90 patients). In the Cox regression model (likelihood ratio 110.9; p < 2 × 10-16), the variables that significantly correlated to 90-day mortality were age (less than 75 years old is a protective factor, HR 0.29 [95%CI 0.16-0.54]; p < 0.001); chronic liver disease (HR 4.59 [95%CI 2.56-8.24], p < 0.001); cognitive impairment (HR 2.76 [95%CI 1.78-4.27], p < 0.001); intracerebral haemorrhage (HR 15.38 [95%CI 6.13-38.63], p < 0.001); and hospitalization (HR 2.56 [95%CI 1.67-3.92], p < 0.001). Cardiovascular disease (47% vs. 11%; p < 0.001) and cognitive impairment (36% vs. 10%; p < 0.001) were more prevalent in patients over 75 years of age than the rest of the population. Conclusions: In our cohort of patients with mild TBI, 90-day mortality was low but not negligible. The risk factors associated with 90-day mortality included age, history of chronic liver disease, and cognitive impairment, as well as evidence of intracerebral hemorrhage and hospitalization. The mortality of the sub-population of older patients was likely to be linked to cardiovascular comorbidities and neurodegenerative diseases.
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Affiliation(s)
- Daniele Orso
- Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Via Pozzuolo 330, 33100 Udine, Italy
| | - Giulia Furlanis
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Alice Romanelli
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Federica Gheller
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Marzia Tecchiolli
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Franco Cominotto
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
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Durak AA, Ergin M, Gürü S, Oğuztürk H, Celik GK, Gökhan S, Ceyhan MA. Impact of COVID-19 Lockdown on Traumatic Bone Fracture Patterns and Hospital Outcomes in 1646 Elderly Patients: A Retrospective Study in Turkey. Med Sci Monit 2024; 30:e942916. [PMID: 38263690 PMCID: PMC10826199 DOI: 10.12659/msm.942916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/08/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND During the Coronavirus Disease-2019 (COVID-19) pandemic-related lockdowns, modifications in trauma-related behavior and other factors in the elderly population may have occurred. The present retrospective study aimed to compare outcomes from emergency admissions to a major trauma center in Turkey of 1646 elderly patients with traumatic bone fractures that occurred before, during, and after the COVID-19 pandemic lockdown period. MATERIAL AND METHODS A cohort of 1646 elderly trauma patients admitted between September 15, 2019 and September 15, 2020 were retrospectively scanned from the hospital registry system and were grouped as admitted during the COVID-19 pandemic before (Group 1), during (Group 2), or after (Group 3) the lockdown restrictions. Demographic and clinical data were examined by making comparisons between the 3 groups. RESULTS In all groups, female sex was more prevalent. Fractures were more common in the ulna and femur than in other bones (P=0.026, P=0.035). Among the groups, in Group 2, injuries due to the mechanism of falling from one's own height on the ground were more prominent (79.2%). Hospital costs were lower in Group 1 (P<0.001). The majority of hospitalized patients (n=874; 53.1%) were in Group 2 (P=0.009). CONCLUSIONS During pandemic lockdowns, the mechanism of falling from one's own height was more common in the elderly population. The ulna and femur were the predominant bones fractured. Therefore, during lockdown periods, precautions should be taken to prevent the elderly from falling from their own height.
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Affiliation(s)
- Ahmet Akif Durak
- Department of Emergency Medicine, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Mehmet Ergin
- Department of Emergency Medicine, Faculty of Medicine, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Selahattin Gürü
- Department of Emergency Medicine, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Hakan Oğuztürk
- Department of Emergency Medicine, Ankara Bilkent City Hospital, Health Science University, Ankara, Turkey
| | - Gülhan Kurtoglu Celik
- Department of Emergency Medicine, Faculty of Medicine, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Servan Gökhan
- Department of Emergency Medicine, Faculty of Medicine, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Mehmet Ali Ceyhan
- Department of Emergency Medicine, Ankara Bilkent City Hospital, Health Science University, Ankara, Turkey
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Maek T, Fochtmann U, Jungbluth P, Pass B, Lefering R, Schoeneberg C, Lendemans S, Hussmann B. Reality of treatment for severely injured patients: are there age-specific differences? BMC Emerg Med 2024; 24:14. [PMID: 38267869 PMCID: PMC10807120 DOI: 10.1186/s12873-024-00935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Major trauma and its consequences are one of the leading causes of death worldwide across all age groups. Few studies have conducted comparative age-specific investigations. It is well known that children respond differently to major trauma than elderly patients due to physiological differences. The aim of this study was to analyze the actual reality of treatment and outcomes by using a matched triplet analysis of severely injured patients of different age groups. METHODS Data from the TraumaRegister DGU® were analyzed. A total of 56,115 patients met the following inclusion criteria: individuals with Maximum Abbreviated Injury Scale > 2 and < 6, primary admission, from German-speaking countries, and treated from 2011-2020. Furthermore, three age groups were defined (child: 3-15 years; adult: 20-50 years; and elderly: 70-90 years). The matched triplets were defined based on the following criteria: 1. exact injury severity of the body regions according to the Abbreviated Injury Scale (head, thorax, abdomen, extremities [including pelvis], and spine) and 2. level of the receiving hospital. RESULTS A total of 2,590 matched triplets could be defined. Traffic accidents were the main cause of severe injury in younger patients (child: 59.2%; adult: 57.9%). In contrast, low falls (from < 3 m) were the most frequent cause of accidents in the elderly group (47.2%). Elderly patients were least likely to be resuscitated at the scene. Both children and elderly patients received fewer therapeutic interventions on average than adults. More elderly patients died during the clinical course, and their outcome was worse overall, whereas the children had the lowest mortality rate. CONCLUSIONS For the first time, a large patient population was used to demonstrate that both elderly patients and children may have received less invasive treatment compared with adults who were injured with exactly the same severity (with the outcomes of these two groups being opposite to each other). Future studies and recommendations should urgently consider the different age groups.
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Affiliation(s)
- Teresa Maek
- Department of Orthopedics and Trauma Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany
| | - Ulrike Fochtmann
- Department of Orthopedics and Trauma Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany
| | - Pascal Jungbluth
- Department of Orthopedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bastian Pass
- Department of Orthopedics and Trauma Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Herdecke University, Ostmerheimer Straße 200, 51109, WittenCologne, Germany
| | - Carsten Schoeneberg
- Department of Orthopedics and Trauma Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany
| | - Sven Lendemans
- Department of Orthopedics and Trauma Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany
- University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Bjoern Hussmann
- Department of Orthopedics and Trauma Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
- Department of Orthopedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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Schlautmann D, Raschke M, Weiss U, Wieskötter B, Ueberberg J, Juhra C. [Bicycle accidents in the course of time in Münster, Germany : Analysis of changes in bicycle accidents over the past 10 years]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:54-61. [PMID: 36715720 PMCID: PMC9885904 DOI: 10.1007/s00113-022-01287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bicycles have been a popular means of transport for many years. Especially in times of increased climate discussion, the bicycle has moved further into focus as an environmentally friendly and cost-effective means of transport. Bike lanes and roads are becoming more crowded and new means of transport such as pedelecs or e‑scooters are emerging. METHODS A total of four studies by Münster University Hospital on bicycle accidents and the official accident statistics of the Münster police were compared. In the period from 2009 to 2019, three studies were conducted that considered all bicycle accidents and one study that only considered pedelec riders separately. RESULTS The age distribution as well as main causes of accidents remained almost the same over the years. The number of pedelec accidents has increased. Pedelec riders have a higher average age and a higher proportion of intensive care stays; however, this cohort also has a high rate of helmet wearers. Overall, the willingness to wear a helmet seems to have increased. CONCLUSION It should be considered that with increasing bicycle traffic, safety measures must be increased accordingly. In this respect, accident prevention should focus on three major areas, engineering, education and enforcement.
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Affiliation(s)
- Désirée Schlautmann
- St. Franziskus Hospital Münster, Hohenzollernring 70, 48145, Münster, Deutschland.
| | | | - Udo Weiss
- Polizeipräsidium Münster, Münster, Deutschland
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Pearcy C, Grossman Verner HM, Figueroa BA, Burris J, Truitt MS, Karpisek A. Appropriate Imaging for Geriatric Trauma. Am Surg 2023; 89:4531-4535. [PMID: 35981527 DOI: 10.1177/00031348221121545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trauma is the leading cause of preventable death in the United States. Early detection of life-threatening injuries leads to improved survival. Computed tomography (CT) scanning has become the modality of choice for early detection of injuries in the stable patient. Some studies have associated selective imaging (Selective-CT) with equivalent outcomes compared to whole body imaging (Pan-CT) with lower costs and radiation exposure. Within the geriatric population, however, the utility of Pan-CT remains controversial. Therefore, the aim of this study was to determine if a difference exists between Selective-CT and Pan-CT imaging in the geriatric trauma patient. METHODS A retrospective analysis of Level 3 (G60) trauma activations presenting to our urban Level I trauma center between June 2016 and June 2019 was performed. Pan-CT was defined by ICD-10 codes indicating a head, cervical spine, chest, abdomen, and pelvis CT series. Patients with missing images and those who were transferred from other institutions were excluded. Logistic regression controlling for age, gender, injury type, severity, and Glasgow Coma Score was performed. RESULTS A total of 1014 patients met inclusion criteria. Of these, 30.9% underwent Pan-CT (n = 314), 48.9% had Selective-CT (n = 497), and 20.2% received no CT imaging (n = 203). After logistic regression, no clinically significant variations in emergency department length of stay (LOS), hospital LOS, ICU LOS, ventilator days, discharge disposition, missed injury rate, or mortality rate were observed between imaging strategies. CONCLUSIONS Pan-CT provides no clinically significant advantage over Selective-CT in the geriatric trauma patient.
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Affiliation(s)
- Christopher Pearcy
- Department of Graduate Medical Education, Methodist Dallas Medical Center, Dallas, TX, USA
| | | | - Brian A Figueroa
- Clinical Research Institute, Methodist Health System, Dallas, TX, USA
| | - Jennifer Burris
- Associates in Surgical Acute Care,Methodist Health System, Dallas, TX, USA
| | - Michael S Truitt
- Department of Graduate Medical Education, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Andrew Karpisek
- Associates in Surgical Acute Care,Methodist Health System, Dallas, TX, USA
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Brandt O, Tjardes T, Grimaldi G, Mutschler M, Imach S. [Analysis of risk factors for dropping out of residency in orthopedics and trauma surgery]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:788-798. [PMID: 36357588 PMCID: PMC10520118 DOI: 10.1007/s00113-022-01249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Currently, there are no data available on dropouts from residency programs and changes of clinic in orthopedics and trauma surgery (O&T). The aim of the study is to identify personal and structural risk factors leading to dropout or switching of postgraduate training in O&T in order to present solution strategies. METHODS A nationwide anonymous online survey was conducted among residents in O&T in summer 2020. Official mail addresses were identified via the Traumanetzwerk© of the DGU and the German Hospital Federation (n = 2090). A questionnaire (51 questions) was administered using SurveyMonkey (San Mateo, CA, USA). All residents who worked in O&T for at least 1 month in the 6 years prior to the start of the survey (from 07/2014) were eligible to participate. A binary logistic regression was calculated to identify the risk factors. The significance level was p = 0.05. RESULTS Of the 221 respondents, 37% switched hospital and 5% dropped out altogether. The regression revealed 3 significant risk factors for switching hospitals. Living in a partnership (p = 0.029, RR: 2.823) and less than 2 days of shadowing before the start of residency (p = 0.002, RR: 2.4) increased the risk of switching. Operating room (OR) allocation of residents according to the training plan/status (p = 0.028, RR: 0.48) reduces the risk of switching. Significant risk factors for leaving postgraduate training could not be determined (insufficient number of cases, n = 11). DISCUSSION Switching the hospital and residency dropouts in O&T are a relevant problem (42%). Gender has no significant influence. Tools such as longer job shadowing, as well as OR allocation according to the training plan/status can minimize the risk of switching.
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Affiliation(s)
- Oskar Brandt
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln gGmbH, Krankenhaus Köln-Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 220, 51109, Köln, Deutschland
| | - Thorsten Tjardes
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln gGmbH, Krankenhaus Köln-Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 220, 51109, Köln, Deutschland
| | - Gina Grimaldi
- Universitätsklinik für Unfallchirurgie, Otto von Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - Manuel Mutschler
- Abteilung für Fuß und Sprunggelenkschirurgie, Waldkrankenhaus Bonn, Johanniter GmbH, Universität Witten/Herdecke, Bonn, Deutschland
| | - Sebastian Imach
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln gGmbH, Krankenhaus Köln-Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 220, 51109, Köln, Deutschland.
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Xu X, Zheng Q, Wei S, Chen Y, Hu X. Follow-up analysis of quality of life in elderly patients with bone trauma: a longitudinal observational study. BMC Geriatr 2023; 23:606. [PMID: 37759165 PMCID: PMC10538243 DOI: 10.1186/s12877-023-04325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The quality of life (QoL) of elderly patients with bone trauma is significantly decreased and is affected by many complex factors. This study aims to conduct a half-year follow-up survey to clarify QoL and its influencing factors in elderly patients with bone trauma in order to provide targeted care measures for elderly patients with bone trauma. METHODS This was a longitudinal observational study. We used the 36-Item Short Form Health Survey (SF-36) to investigate and evaluate the QoL of 100 patients with bone trauma at the time of hospital discharge and 1 month, 3 months, and 6 months after discharge. Our previous study confirmed that the SF-36 had higher reliability and validity for evaluating the QoL of elderly patients with bone trauma. At the same time, we also investigated the age, gender, location of bone trauma, and destination after discharge of those patients. Those factors that might affect the QoL of elderly patients with bone trauma were identified by univariate and multivariate analyses. RESULTS The total physiological function, role-physical, bodily pain, vitality, social functioning, role-emotional, and mental health scores of elderly patients with bone trauma gradually increased from the time of discharge to 1 month, 3 months, and 6 months after discharge, and there were significant differences (p < 0.001). However, there was no significant difference in the general health score in the different periods (P = 0.095). The total QoL scores also significantly differed (F = 118.61, P < 0.001) at the time of discharge (335.252 ± 127.572) and 1 month (285.149 ± 112.827), 3 months (479.344 ± 153.663), and 6 months after discharge (544.396 ± 166.536). The univariate analysis results showed that the location of bone trauma (P < 0.005) and the destination after discharge (P < 0.001) were the main factors affecting QoL in different periods. The results of the multivariate analysis showed that the location of bone trauma was an important factor affecting QoL (P < 0.005 in different periods). Whether to undergo surgery was a factor affecting the patients' long-term QoL (P < 0.005 at 6 months after discharge). CONCLUSIONS Although the QoL of elderly patients with bone trauma gradually improves after injury, their recovery time is long, and the influencing factors are complex. Follow-up services should continue for at least six months for these patients, and comprehensive treatment and long-term rehabilitation services should be provided.
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Affiliation(s)
- Xiaofeng Xu
- Division of Vascular Surgery, Department of General Surgery, Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Qixiang Zheng
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Siying Wei
- West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Yongmei Chen
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiuying Hu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China.
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12
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Bonne S. Social Care Is Medical Care. JAMA Surg 2023; 158:953. [PMID: 37405792 DOI: 10.1001/jamasurg.2023.2507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
- Stephanie Bonne
- Trauma and Critical Care Surgery, Hackensack University Medical Center, Hackensack, New Jersey
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Mohd Mokhtar MA, Azhar ZI, Jamaluddin SF, Cone DC, Shin SD, Shaun GE, Chiang WC, Kajino K, Song KJ, Son DN, Norzan NA. Analysis of Trauma Characteristics Between the Older and Younger Adult Patient from the Pan Asian Trauma Outcome Study Registry (PATOS). PREHOSP EMERG CARE 2023; 27:875-885. [PMID: 37459651 DOI: 10.1080/10903127.2023.2237107] [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: 02/23/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Asia is experiencing a demographic shift toward an aging population at an unrivaled rate. This can influence the characteristics and outcomes of trauma. We aim to examine different characteristics of older adult trauma patients compared to younger adult trauma patients and describe factors that affect the outcomes in Asian countries. METHODS This is a retrospective, international, multicenter study of trauma across participating centers in the Pan Asian Trauma Outcome Study (PATOS) registry, which included trauma cases aged ≥18 years, brought to the emergency department (ED) by emergency medical services (EMS) from October 2015 to November 2018. Data of older adults (≥65 years) and younger adults (<65 years) were analyzed and compared. The primary outcome measure was in-hospital mortality, and secondary outcomes were disability at discharge and hospital and intensive care unit (ICU) length of stays. RESULTS Of 39,804 trauma patients, 10,770 (27.1%) were older adults. Trauma occurred more among older adult women (54.7% vs 33.2%, p < 0.001). Falls were more frequent in older adults (66.3% vs 24.9%, p < 0.001) who also had higher mean Injury Severity Score (ISS) compared to the younger adult trauma patient (5.4 ± 6.78 vs 4.76 ± 8.60, p < 0.001). Older adult trauma patients had a greater incidence of poor Glasgow Outcome Scale (GOS) (13.4% vs 4.1%, p < 0.001), higher hospital mortality (1.5% vs 0.9%, p < 0.001) and longer median hospital length of stay (12.8 vs 9.8, p < 0.001). Multiple logistic regression revealed age (adjusted odds ratio [AOR] 1.06, 95%CI 1.02-1.04, p < 0.001), male sex (AOR 1.60, 95%CI 1.04-2.46, p = 0.032), head and face injuries (AOR 3.25, 95%CI 2.06-5.11, p < 0.001), abdominal and pelvic injuries (AOR 2.78, 95%CI 1.48-5.23, p = 0.002), cardiovascular (AOR 2.71, 95%CI 1.40-5.22, p = 0.003), pulmonary (AOR 3.13, 95%CI 1.30-7.53, p = 0.011) and cancer (AOR 2.03, 95%CI 1.02-4.06, p = 0.045) comorbidities, severe ISS (AOR 2.06, 95%CI 1.23-3.45, p = 0.006), and Glasgow Coma Scale (GCS) ≤8 (AOR 12.50, 95%CI 6.95-22.48, p < 0.001) were significant predictors of hospital mortality. CONCLUSIONS Older trauma patients in the Asian region have a higher mortality rate than their younger counterparts, with many significant predictors. These findings illustrate the different characteristics of older trauma patients and their potential to influence the outcome. Preventive measures for elderly trauma should be targeted based on these factors.
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Affiliation(s)
- Mohd Amin Mohd Mokhtar
- Faculty of Medicine, Universiti Teknologi MARA, UiTM Sungai Buloh Campus, Sungai Buloh, Malaysia
| | - Zahir Izuan Azhar
- Faculty of Medicine, Universiti Teknologi MARA, UiTM Sungai Buloh Campus, Sungai Buloh, Malaysia
| | | | | | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Goh E Shaun
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Wen Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Yunlin Branch, National Taiwan University Hospital, Douliu City, Taiwan
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Japan
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Do Ngoc Son
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
| | - Nurul Azlean Norzan
- Emergency and Trauma Department, Sungai Buloh Hospital, Sungai Buloh, Malaysia
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14
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Höller S, Wübbeke LF, Apel J, Hawellek T, Sehmisch S, Wiedenhöft J, Lehmann W, Hoffmann DB. Retrospective In-Hospital Mortality Analysis of GeriatricPatients Treated in a Level 1 Trauma Center. J Clin Med 2023; 12:jcm12103466. [PMID: 37240572 DOI: 10.3390/jcm12103466] [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: 12/29/2022] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study is to determine the critical time intervals and influencing covariates for in-hospital mortality in geriatric trauma and orthopedic patients. During a period of five years, we retrospectively review patients aged > 60 years who were hospitalized at the Department of Trauma, Orthopedic, and Plastic Surgery. The primary outcome is the mean time to death. Survival analysis is performed using an accelerated failure time model. A total of 5388 patients are included in the analysis. Two-thirds underwent surgery (n = 3497, 65%) and one-third were conservatively treated (n = 1891, 35%). The in-hospital mortality rate is 3.1% (n = 168; surgery, n = 112; conservative, n = 56). The mean time to death is 23.3 days (±18.8) after admission in the surgery group and 11.3 days (±12.5) in the conservative treatment group. The greatest accelerating effect on mortality is found in the intensive care unit (16.52, p < 0.001). We are able to identify a critical time interval for in-hospital mortality between days 11 and 23. The day of death on weekend days/holidays, hospitalization for conservative treatment, and treatment at the intensive care unit significantly increase the risk of in-hospital mortality. Early mobilization and a short hospitalization duration seem to be of major importance in fragile patients.
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Affiliation(s)
- Sebastian Höller
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Lina F Wübbeke
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Jamina Apel
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Thelonius Hawellek
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Stephan Sehmisch
- Department of Trauma Surgery, Medical School Hannover, 30625 Hannover, Germany
| | - John Wiedenhöft
- Scientific Core Facility for Medical Biometry and Statistical Bioinformatics (MBSB), University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Daniel B Hoffmann
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
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15
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Erne F, Wallmeier V, Ihle C, Braun BJ, Ehnert S, Histing T, Nüssler AK, Maurer E. The modified 5-item frailty index determines the length of hospital stay and accompanies with mortality rate in patients with bone and implant-associated infections after trauma and orthopedic surgery. Injury 2023; 54:1125-1131. [PMID: 36754703 DOI: 10.1016/j.injury.2023.01.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Bone and implant-associated infections are severe complications after trauma and orthopedic surgery. The modified 5-item frailty index (mFI-5) is an easily applicable score to predict adverse outcome after surgery. The current literature regarding mFI-5 is focused on a period of 30-days postoperative. PURPOSE This study aims to assess the impact of frailty in orthopedic trauma patients with bone and implant-associated infections. mFI-5 was calculated from a database, which prospectively collects data about factors potentially correlated with peri- and postoperative complications since 2014. METHODS In a level I trauma center a total of 345 patients with surgical site infections were enrolled in this study. Hereof, patients with fracture-related infections after osteosynthesis, periprosthetic joint infections of the hip and knee and post-operative osteomyelitis were included. Extensive medical baseline examination was performed in 2013/14, a three-year follow-up was organized as a telephone interview. The mFI-5 score was calculated based on the 5 factor-principle as established by Subramaniam. The nutritional status was assessed using the Nutritional Risk Screening (NRS-2002). RESULTS 130 patients were included, whereof seven had died, resulting in 123 patients. A grouping of our patients was performed in mFI-5 = 0 (n = 46; 36,4%), mFI-5 = 1 (n = 41; 33,3%) or mFI-5 ≥ 2 (n = 36; 29,3%). Sex distribution showed 69,1% male and 30,9% female patients. Frailty did neither impact on the re-admission (p = 0,433) nor the reoperation (p = 0,327) rate in our cohort. The mortality risk nearly doubled (1,7 times) in frail patients, but did not reach significance. In hospital stay was prolonged due to frailty (12,1 ± 11,8; p = 0,004) compared to those with a mFI-5 = 0 (5,9 ± 5,1) or mFI-5 = 1 (6,9 ± 5,9). Frailty goes along with a risk of malnutrition and increases with age. CONCLUSION The modified 5-item frailty index is not a suitable screening tool for predicting revision rate, re-admission rate, and mortality in our orthopedic trauma patient population with bone and implant-associated infections. Nevertheless, frailty is associated with an increased risk of malnutrition and increases with age.
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Affiliation(s)
- Felix Erne
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Vera Wallmeier
- Klinik für Hals-Nasen-Ohrenkrankheiten, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Christoph Ihle
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Benedikt J Braun
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Sabrina Ehnert
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Andreas K Nüssler
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Elke Maurer
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany.
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16
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Tapking C, Rontoyanni VG, Diehm YF, Strübing F, Solimani F, Bigdeli AK, Hundeshagen G, Fischer S, Kneser U, Siegwart LC. Enzymatic Debridement in Geriatric Burn Patients—A Reliable Option for Selective Eschar Removal. J Clin Med 2023; 12:jcm12072633. [PMID: 37048716 PMCID: PMC10095072 DOI: 10.3390/jcm12072633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
The treatment of geriatric burn patients represents a major challenge in burn care. The objective of this study was to evaluate the efficacy of enzymatic debridement (ED) in geriatric burn patients. Adult patients who received ED for treatment of mixed pattern and full thickness burns (August 2017–October 2022) were included in this study and grouped in the younger (18–65 years) and geriatric (≥65 years) groups. Primary outcome was a necessity of surgery subsequent to ED. Both groups (patient characteristics, surgical and non-surgical treatment) were compared. Multiple logistic and linear regression models were used to identify the effect of age on the outcomes. A total of 169 patients were included (younger group: 135 patients, geriatric group: 34 patients). The burn size as indicated by %TBSA (24.2 ± 20.4% vs. 26.8 ± 17.1%, p = 0.499) was similar in both groups. The ASA (2.5 ± 1.1 vs. 3.4 ± 1.1, p < 0.001) and ABSI scores (6.1 ± 2.8 vs. 8.6 ± 2.3, p < 0.001) were significantly higher in the geriatric group. The %TBSA treated with ED (5.4 ± 5.0% vs. 4.4 ± 4.3%, p = 0.245) were similar in both groups. The necessity of additional surgical interventions (63.0 % vs. 58.8 %, p = 0.763) and the wound size debrided and grafted (2.9 ± 3.5% vs. 2.2 ± 2.1%; p = 0.301) were similar in both groups. Regression models yielded that age did not have an effect on efficacy of ED. We showed that ED is reliable and safe to use in geriatric patients. Age did not have a significant influence on the surgical outcomes of ED. In both groups, the size of the grafted area was reduced and, in many patients, surgery was avoided completely.
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Affiliation(s)
- Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | | | - Yannick F. Diehm
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Felix Strübing
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, 10178 Berlin, Germany
| | - Amir K. Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Sebastian Fischer
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Laura C. Siegwart
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
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17
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Eryurt SC, Sahin T, Oral S. Evaluation of factors affecting prognosis and mortality in geriatric patients presented to the emergency service with head trauma. Aging Med (Milton) 2023. [DOI: 10.1002/agm2.12247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Affiliation(s)
- Sadettin Cagrı Eryurt
- Emergency Medicine Service Diyarbakır Selahaddin Eyyubi Government Hospital Diyarbakır Turkey
| | - Taner Sahin
- Department of Emergency Medicine Kayseri City Hospital Affiliated with University of Health Science Kayseri Faculty of Medicine Kayseri Turkey
| | - Sukru Oral
- Department of Neurosurgery Erciyes University Faculty of Medicine Kayseri Turkey
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18
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Badrinathan A, Ho VP, Tinkoff G, Houck O, Vazquez D, Gerrek M, Kessler A, Rushing A. Are we waiting for the sky to fall? Predictors of withdrawal of life-sustaining support in older trauma patients: A retrospective analysis. J Trauma Acute Care Surg 2023; 94:385-391. [PMID: 36449699 PMCID: PMC9974547 DOI: 10.1097/ta.0000000000003844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Limited data exist regarding the impact of advanced care planning for injured geriatric patients. We hypothesized that patients with advance directives limiting care (ADLC) compared with those without ADLC are more likely to undergo withdrawal of life-sustaining support (WLSS). METHODS This is a propensity-matched analysis utilizing American College of Surgeons Trauma Quality Improvement Program patients 65 years or older who presented between 2017 and 2018. Patients with and without ADLC on admission were compared. The primary outcome was WLSS and days prior to WLSS. Additional factors examined included hospital length of stay (LOS), unplanned operations, unplanned intensive care unit admissions, and in-hospital cardiac arrests. Prior to matching, logistic regression model assessed factors associated with WLSS. Patients with and without ADLC were matched 1:1 via a propensity score using patient and injury factors as covariates, and matched pair analysis compared differences in WLSS between patients with and without ADLC. RESULTS There were 597,840 patients included: 44,001 patients with an ADLC (7.36%) compared with 553,839 with no ADLC (92.64%). Patients with an ADLC underwent WLSS more often than those with no ADLC (7.68% vs. 2.48%, p < 0.001). In a 1:1 propensity-matched analysis, patients with ADLC were more likely to undergo WLSS (odds ratio [OR], 2.38' 95% confidence interval [CI], 2.22-2.55), although stronger predictors of WLSS included severity of injury (Injury Severity Score, 25+; OR, 23.84; 95% CI, 21.55-26.36), unplanned intensive care unit admissions (OR, 3.30; 95% CI, 2.89-3.75), and in-hospital cardiac arrests (OR, 4.97; 95% CI, 4.02-6.15). CONCLUSION A small proportion of the geriatric trauma population had ADLC on admission. While ADLC was predictive of WLSS, adverse events were more strongly associated with WLSS. To ensure patient-centered care and reduce futile interventions, surgeons should delineate goals of care early regardless of ADLC. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
| | - Vanessa P Ho
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, MetroHealth Medical Center, Cleveland, Ohio
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Glen Tinkoff
- Department of Surgery, University Hospitals Cleveland Medical Center
- Northern Ohio Trauma System, Brooklyn Heights, Ohio
| | - Olivia Houck
- Northern Ohio Trauma System, Brooklyn Heights, Ohio
| | - Daniel Vazquez
- Division of Trauma, Cleveland Clinic Foundation, Akron General Hospital, Akron, Ohio
| | - Monica Gerrek
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Center for Biomedical Ethics, The MetroHealth System, Cleveland, OH
| | - Ann Kessler
- Rainbow Babies and Children’s Center for Bioethics, University Hospitals, Cleveland, Ohio
| | - Amy Rushing
- Department of Surgery, University Hospitals Cleveland Medical Center
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19
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Alter SM, Gonzalez MR, Solano JJ, Clayton LM, Hughes PG, Shih RD. Comparing rates of skull fractures in female versus male geriatric patients who sustain head injuries. Am J Emerg Med 2023; 65:168-171. [PMID: 36640625 DOI: 10.1016/j.ajem.2022.12.044] [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: 09/26/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Head trauma is the leading cause of serious injury in the older adult population with skull fractures as a serious reported outcome. This study aims to evaluate the role of sex in the risk of skull fracture in patients over the age of 65. METHODS A prospective cohort study was conducted at two level-one trauma centers, serving a population of 360,000 geriatric residents. Over a year-long period, consecutive patients aged 65 years and older who presented with blunt head injury were included. Patients who did not receive head CT imaging were excluded. The primary outcome was rate of skull fracture due to the acute trauma, compared by sex. Additional factors examined included patient race/ethnicity and mechanism of injury. RESULTS Among 5402 patients enrolled, 3010 (56%) were female and 2392 (44%) were male. 4612 (85%) of the head injuries sustained were due to falls, and 4536 (90%) of all subjects were Caucasian. Overall, 199 patients (3.7%) sustained skull fractures. Males had a significantly greater rate of skull fracture when compared to females (4.6% vs 3.0%, OR 1.5, 95% CI: 1.2-2.1, p = 0.002). This trend was also seen across race/ethnicity and mechanism of injury. CONCLUSIONS Older males were found to have a higher rate of skull fractures compared to females after sustaining blunt head trauma, mostly due to falls.
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Affiliation(s)
- Scott M Alter
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA; Department of Emergency Medicine, Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484, USA.
| | - Michelly R Gonzalez
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA.
| | - Joshua J Solano
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA; Department of Emergency Medicine, Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484, USA.
| | - Lisa M Clayton
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA; Department of Emergency Medicine, Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484, USA.
| | - Patrick G Hughes
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA; Department of Emergency Medicine, Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484, USA.
| | - Richard D Shih
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA; Department of Emergency Medicine, Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484, USA.
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20
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Wollner G, Weihs V, Frenzel S, Aldrian S, Negrin LL. Musculus psoas major morphology - a novel predictor of mortality in elderly polytraumatized patients. BMC Emerg Med 2023; 23:13. [PMID: 36750772 PMCID: PMC9903455 DOI: 10.1186/s12873-023-00783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Numerous papers in different fields have already shown that CT imaging of the Musculus Psoas Major (MPM) can be used to predict patient outcome. Unfortunately, most of the methods presented in the literature are very complex and not easy to perform in the clinic. Therefore, the objectives of the study were to introduce a novel and convenient method for measuring the MPM to trauma surgeons and to prove the association between MPM morphology and mortality in elderly polytraumatized patients. MATERIAL AND METHODS The retrospective outcome study was conducted at our level I trauma center. All patients admitted from 2006 to 2020 were included if they (1) presented with multiple injuries (≥2 body regions) and an Injury Severity Score (ISS) ≥16, (2) were at least 65 years of age, and (3) were diagnosed using a whole-body computed tomography. Subsequently, the ratios of short-axis to long-axis of both MPM were measured, and their mean value was evaluated as a candidate predictor of 31-day mortality. RESULTS Our study group consisted of 158 patients (63.3% male; median age, 76 years; median ISS, 25). In the survivors (55.7%), the mean MPM score was significantly higher compared to the fatalities (0.57 versus 0.48; p < 0.0001). Multivariate binary logistic regression analysis identified the MPM score as a protective predictor of 31 day-mortality (OR = 0.92, p < 0.001), whereas age (OR 1.08, p = 0.002 and ISS (OR 1.06, p = 0.006) revealed as significant risk factors for mortality. ROC statistics provided an AUC = 0.724 (p < 0.0001) and a cut-off level of 0,48 (sensitivity, 80.7%; specificity, 54.3%). CONCLUSION The present study demonstrated that MPM score levels lower than 0.48 might be considered an additional tool to identify elderly patients at high risk of death following major trauma. In our opinion, the assessment of the MPM score is an easy, convenient, and intuitive method to gain additional information quickly after admission to the hospital that could be implemented without great effort into daily clinical practice.
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Affiliation(s)
- Gregor Wollner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
| | - Valerie Weihs
- grid.22937.3d0000 0000 9259 8492Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephan Frenzel
- grid.22937.3d0000 0000 9259 8492Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Silke Aldrian
- grid.22937.3d0000 0000 9259 8492Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Lukas Leopold Negrin
- grid.22937.3d0000 0000 9259 8492Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
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21
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Muacevic A, Adler JR. Domestic Cow-Related Severe Facial Trauma in an Older Farmer Undergoing Anticoagulation Treatment. Cureus 2022; 14:e29818. [PMID: 36337827 PMCID: PMC9626379 DOI: 10.7759/cureus.29818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/18/2022] Open
Abstract
Domestic cow-related injuries can carry significant morbidity and mortality among livestock farmers. We report a case of an 83-year-old male farmer with severe facial trauma and a potentially compromised airway caused by a domestic dairy cow during his routine work while taking oral anticoagulants. Since head and neck trauma caused by domestic cows can be severe, preventive measures should be taken to protect cattle farmers in those exposed areas.
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22
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Krahelski O, Sivarajah S, Eardley W, Smith TO, Hing CB. Major trauma associated with mobility scooters: An analysis of the trauma audit research network. Injury 2022; 53:3011-3018. [PMID: 35779969 DOI: 10.1016/j.injury.2022.06.019] [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: 12/07/2021] [Revised: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 02/02/2023]
Abstract
AIMS To establish the incidence and nature of injuries seen in patients following mobility scooter incidents. METHODS The Trauma Audit and Research Network (TARN) database was used to collect data concerning injuries associated with mobility scooters. The data was taken from incidents that occurred between February 2014 and November 2020. The data analysed included: patient demographics, injury mechanism and patterns and associated mortality rates. RESULTS 1,504 patients were identified of which 61.4% were male. The median age was 76.2 years (IQR 63.5-84.9). The median injury severity score (ISS) was 9 (IQR 9-17), with major trauma (ISS ≥16) being observed in 29.4% of patients. Injuries to the limb were most common, although injuries to the head were most severe. Vehicle collisions accounted for 65.4% of injuries and were most closely associated with the most severe incidents. The median length of stay in hospital was 12 days, excluding the patients who died. Overall, mortality following injury was 10.6%, but the mortality rate was 15.4% in those aged 75 years and over, and 24.2% in those sustaining severe trauma. CONCLUSION As the population ages, injury characteristics of those with both major and non-major trauma changes. Mobility scooter use is prevalent amongst older people, and we provided a detailed analysis of injuries sustained with their use across a national database. The length of stay and the inherent resource use, because of admission following mobility scooter trauma, is considerable. These injuries particularly affect the 'most elderly' and carry a considerable mortality burden.
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Affiliation(s)
- O Krahelski
- Epsom and St. Helier NHS Foundation Trust, London, United Kingdom
| | - S Sivarajah
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - W Eardley
- James Cook University Hospital, Middlesbrough, United Kingdom; Department of Health Sciences, University of York, United Kingdom
| | - T O Smith
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - C B Hing
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
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23
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Pandya S, Le T, Demissie S, Zaky A, Arjmand S, Patel N, Moko L, Garces J, Rivera P, Singer K, Fedoriv I, Garcia Z, Kennedy J, Makkapati B, Mukherjee I, Szerszen A, Gross J, Glinik G, Younan D. The Association of Gender and Mortality in Geriatric Trauma Patients. Healthcare (Basel) 2022; 10:healthcare10081472. [PMID: 36011129 PMCID: PMC9407800 DOI: 10.3390/healthcare10081472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
The association of gender with mortality in trauma remains a subject of debate. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of gender with mortality in a group of geriatric trauma patients presenting to an academic level 1 trauma center (trauma center designated by New York State capable of handling the most severe injuries and most complex cases). Methods: We performed a retrospective review of geriatric trauma patients who were admitted to our trauma center between January 2018 and December 2020. Data collected included vital signs, demographics, injury, and clinical characteristics, laboratory data and outcome measures. The study controlled for co-morbidities, injury severity score (ISS), and systolic blood pressure (SBP) in the ED. Multivariable logistic regression analysis was performed to evaluate the association of gender and mortality. Results: 4432 geriatric patients were admitted during the study period, there were 1635 (36.9%) men and 3859 (87.2%) were White with an average age of 81 ± 8.5 years. The mean ISS was 6.7 ± 5.4 and average length of stay was 6 ± 6.3 days. There were 165 deaths. Male gender (OR 1.94, 95% CI 1.38 to 2.73), ISS (OR 1.12, 95% CI 1.09 to 1.14), Emergency Department SBP less than 90 mmHg (OR 6.17, 95% CI 3.17 to 12.01), and having more than one co-morbidity (OR 2.28, 95% CI 1.55 to 3.35) were independently predictive of death on multivariable logistic regression analysis. Conclusion: Male gender, Emergency Department systolic blood pressure less than 90 mmHg, having more than one co-morbidity, and injury severity are independent predictors of mortality among geriatric trauma patients.
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Affiliation(s)
- Shreya Pandya
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Timothy Le
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Seleshi Demissie
- Biostatistics Unit, Feinstein Institutes for Medical Research, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Ahmed Zaky
- Department of Anesthesia, The University of Alabama in Birmingham, Birmingham, AL 35294, USA
| | - Shadi Arjmand
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Nikhil Patel
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Lilamarie Moko
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Juan Garces
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Paula Rivera
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Kiara Singer
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Ivan Fedoriv
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Zachery Garcia
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - James Kennedy
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Bhavana Makkapati
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Indraneil Mukherjee
- Department of Surgery, Division of Minimally Invasive Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Anita Szerszen
- Department of Medicine, Division of Geriatric Medicine, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Jonathan Gross
- Department of Orthopedics, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Galina Glinik
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Duraid Younan
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
- Correspondence:
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Banerjee N, Sharma N, Soni KD, Bansal V, Mahajan A, Khajanchi M, Gerdin Wärnberg M, Roy N. Are home environment injuries more fatal in children and the elderly? Injury 2022; 53:1987-1993. [PMID: 35367079 DOI: 10.1016/j.injury.2022.03.050] [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: 11/21/2021] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION 'In-home injuries' are those that occur within the house or its immediate surroundings. The literature on the prevalence and magnitude of home injuries is sparse. This study was designed to characterize the mechanisms of 'in-home' injuries and compare their outcomes with 'outside home injuries'. MATERIALS AND METHODS The Australia-India Trauma Systems Collaboration (AITSC) Project created a multicentric registry consisting of trauma patients admitted at four urban tertiary care hospitals in India from April 2016 to March 2018. This registry data was analysed for this study. All admitted patients except for dead on arrival were included. Patients were categorised into 'in-home' and 'outside home' cohorts based on the place where the trauma occurred. The outcome measures were 30 day in-hospital mortality and the length of hospital stay. Two subgroup analyses were performed, the first comprised pediatric patients (<15 years) and the second elderly patients >64 years). RESULTS Among 9354 patients in the AITSC data registry, 8398 patients were included in the study. Out of these, 29 percent were in-home injuries, whereas the rest occurred outside home. The 30 day in-hospital mortality was 10.6 percent in the 'in-home' cohort, as compared to 13.7 percent in the 'outside home' cohort. This difference although significant on univariable analysis (p <0.01), there was no significant difference on multivariable regression analysis, after adjusting for age and injury severity score (OR = 0.88, 95% CI = 0.73-1.04; p = 0.15). The length of hospital stay was shorter in the home injuries group (median = 5 days; IQR = 3-12 days) compared to the outside-home group (median = 7 days; IQR = 4-14 days) (p < 0.01). In the pediatric and the elderly, on multivariable regression analysis, in-home injuries were associated with higher mortality than outside home injuries. CONCLUSION There was no significant difference in the 30 day in-hospital mortality amongst admitted trauma patients sustaining injuries at home or outside the home. However, in pediatric and elderly patients the chances of mortality was significantly higher when injured at home.
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Affiliation(s)
- Niladri Banerjee
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Naveen Sharma
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Kapil Dev Soni
- Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Bansal
- Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | | | - Monty Khajanchi
- Department of Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Surgical Unit, WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, BARC Hospital (Government of India), Mumbai, India.
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Jones DM, Connelly DW, Burgess JR. Ground Level Falls in Patients Over 60, Do Race and Socioeconomic Status Affect Outcome? Am Surg 2022; 88:2127-2131. [DOI: 10.1177/00031348221091961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Falls are a significant source of morbidity, mortality, and health care spending in the elderly. The objective was to identify whether race, insurance status, and median income by zip code were associated with discharge disposition, readmission within 90 days, or mortality within 1 year of ground-level falls in patients aged 60-90. Materials and Methods We conducted a retrospective chart review of 926 patients aged 60-90 treated for ground-level falls. We created a binomial linear regression model to identify predictors of discharge disposition, 90-day readmission, and mortality within 1 year of discharge. Results Length of stay (P < .01), having orthopedic surgery (P < .01), score on Charlson Comorbidity Index (CCI) (P < .01), increasing age (P = .014), female sex (P = .05), and admission to the ICU (P = .05) were associated with discharge to a secondary facility. Readmission within 90 days was only associated with higher scores on the CCI (P < .01). Charlson Comorbidity Index (P < .0001), hospital length of stay (P < .001), and admission to the ICU (P = .015) were associated with increased mortality at 1 year. Discussion Predictors of discharge to another facility included hospital length of stay, having orthopedic surgery, CCI scores, increasing age, female sex, and admission to the ICU. Charlson Comorbidity Index score was the only significant predictor of readmission. Predictors of mortality at 1-year post-fall included CCI score, hospital length of stay, and admission to the ICU. Race, median income by zip code, and insurance provider were not statistically significant.
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Affiliation(s)
- Da’keesha M. Jones
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Daniel W. Connelly
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jessica R. Burgess
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
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DOI T, HIOKI T, TACHI J, UEDA K, MATSUSHIMA-NISHIWAKI R, IIDA H, OGURA S, KOZAWA O, TOKUDA H. Oncostatin M reduces the synthesis of macrophage-colony stimulating factor stimulated by TGF-β via suppression of p44/p42 MAP kinase and JNK in osteoblasts. Biomed Res 2022; 43:41-51. [DOI: 10.2220/biomedres.43.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tomoaki DOI
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine
| | - Tomoyuki HIOKI
- Department of Pharmacology, Gifu University Graduate School of Medicine
| | - Junko TACHI
- Department of Pharmacology, Gifu University Graduate School of Medicine
| | - Kyohei UEDA
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine
| | | | - Hiroki IIDA
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine
| | - Shinji OGURA
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine
| | - Osamu KOZAWA
- Department of Pharmacology, Gifu University Graduate School of Medicine
| | - Haruhiko TOKUDA
- Department of Clinical Laboratory/Medical Genome Center, National Center for Geriatrics and Gerontology
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27
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Berk T, Halvachizadeh S, Backup J, Kalbas Y, Rauer T, Zettl R, Pape HC, Hess F, Welter JE. Increased injury severity and hospitalization rates following crashes with e-bikes versus conventional bicycles: an observational cohort study from a regional level II trauma center in Switzerland. Patient Saf Surg 2022; 16:11. [PMID: 35248128 PMCID: PMC8897912 DOI: 10.1186/s13037-022-00318-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background As electric bicycles (e-bikes) become increasingly popular, reports of injuries associated with e-bike usage are also rising. Patterns, characteristics, and severity of injuries following e-bike crashes need further investigation, particularly in contrast to injuries from conventional bicycle crashes. Methods This prospective observational study included 82 patients treated at a Level II trauma center for injuries resulting from an electric or conventional bicycle crash. Data were collected over one year (05.09.2017–19.09.2018) during in- and outpatient visits. A study-specific case report form was used to identify the bicycle type, cycling behavior (e.g., use of a helmet, safety gear, alcohol), and circumstances of the crash (e.g., road conditions, speed, cause of the incident, time of day, season). Additional information about patient demographics, treatment, and injury characteristics, such as the Injury Severity Score (ISS) and body region injured, were documented. Results were analyzed using chi-square, Fisher’s exact, or Wilcoxon tests. Simple logistic or linear regression models were used to estimate associations. Results Of the 82 patients, 56 (67%) were riding a conventional bike and 27 (33%) were using an e-bike. Most incidents were either single-bicycle crashes (66%) or automobile collisions (26%), with no notable difference in prevalence rates between groups. Although a higher proportion of conventional bikers were male (67% vs. 48%), the difference was not significant. E-bikers were older (median 60 years (IQR 44–70) vs. 45 years (IQR 32–62); p = 0.008), were hospitalized more often (48% vs. 24%, p = 0.025), and had worse ISS (median 3 (IQR 2–4) vs. 1 (IQR 1–3), p < 0.001), respectively. Body regions most affected were the extremities (78%) and external/skin (46%), and these were distributed similarly in both groups. Concomitant injury patterns of the thorax/chest with external/skin were higher among e-bikers (p < 0.001). When we controlled for the difference in the median age of the two groups, only the injury severity score of e-bikers remained significantly worse. Conclusions Hospitalization and chest trauma rates were higher among e-bikers. After controlling for the older age of this group, the severity of their injuries remained worse than in conventional cyclists. Initial clinical assessments at trauma units should include an evaluation of the thorax/chest, particularly among elderly e-bikers. Level of evidence Level III.
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Affiliation(s)
- Till Berk
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. .,Division of Traumatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Sascha Halvachizadeh
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Johannnes Backup
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - Yannik Kalbas
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Rauer
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ralph Zettl
- Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Florian Hess
- Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Jo Ellen Welter
- Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
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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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Mouri N, Ohta R, Sano C. Effects of Shopping Rehabilitation on Older People's Daily Activities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010569. [PMID: 35010839 PMCID: PMC8744656 DOI: 10.3390/ijerph19010569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/01/2023]
Abstract
In an aged society, the deterioration of physical and cognitive functions is prevalent. To motivate the rehabilitation of older persons, an initiative known as “shopping rehabilitation” incorporates shopping as an element of a nudge. The purpose of this study was to clarify motor function changes and cognitive functions of participants during shopping rehabilitation, through a semi-experimental study. We measured changes in the Kihon Checklist score before and after rehabilitation interventions. A paired t-test was used to analyze changes in the overall score of the basic checklist before and after the rehabilitation intervention. In December 2020, 59 participants answered the Kihon Checklist after their shopping rehabilitation intervention. During the 6-month intervention period, the number of participants with a checklist score of 8 or higher was significantly reduced after the intervention (p = 0.050). In the sub-analysis, the score improved significantly for the group with families (p = 0.050). Improvement was observed in the group living alone, but the difference was not significant (p = 0.428). The shopping rehabilitation intervention improved the Kihon Checklist score. Continuous observations and research are necessary to measure the long-term effects of shopping rehabilitation and the mechanisms that foster their maintenance and effects.
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Affiliation(s)
- Naoto Mouri
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (N.M.); (C.S.)
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-Cho, Unnan 699-1221, Japan
| | - Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-Cho, Unnan 699-1221, Japan
- Correspondence: ; Tel.: +81-9050605330
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (N.M.); (C.S.)
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Influencing Factors and Prevention of Sepsis or Acute Kidney Injury in 85 Patients with Severe Trauma. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5754114. [PMID: 34777535 PMCID: PMC8580668 DOI: 10.1155/2021/5754114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022]
Abstract
Severe trauma can cause systemic reactions, leading to massive bleeding, shock, asphyxia, and disturbance of consciousness. At the same time, patients with severe trauma are at high risk of sepsis and acute renal injury. The occurrence of complications will increase the difficulty of clinical treatment, improve the mortality rate, and bring heavy physical and mental burdens and economic pressure to patients and their families. It is of great clinical significance to understand the high risk factors of sepsis and AKI and actively formulate prevention and treatment measures. In this study, the clinical data of 85 patients with severe trauma were analyzed by univariate and multivariate logistic regression to identify the risk factors leading to sepsis or AKI and analyze the prevention and treatment strategies. The results showed that multiple injuries, APACHE II score on admission, SOFA score on admission, and mechanical ventilation were independent influencing factors of sepsis in patients with severe trauma, while hemorrhagic shock, APACHE II score on admission, CRRT, and sepsis were independent influencing factors of AKI in patients with severe trauma. Severe trauma patients complicated with sepsis or AKI will increase the risk of death. In the course of treatment, prevention and intervention should be given as far as possible to reduce the incidence of complications.
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Carge MJ, Liberati DM, Diebel LN. A biomimetic shock model on the effect of endothelial aging on vascular barrier properties. J Trauma Acute Care Surg 2021; 91:849-855. [PMID: 34695061 DOI: 10.1097/ta.0000000000003207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aging is characterized by a decline in cellular function, which has an adverse effect on the biologic response to injury. Both aging and trauma/hemorrhagic shock (T/HS) increase oxidative stress which impairs the vascular endothelium (EC) and glycocalyx (EG). The additive effect of aging on EC and EG damage following T/HS are unknown. This was studied in an in vitro model. METHODS Confluent endothelial cell monolayers from primary aortic endothelial cells from 10-week-old mice ("young" cells) or primary aortic cells from 65-week-old mice ("aged" cells) were established in microfluidic devices (MFDs) and perfused at constant shear conditions overnight. Mouse endothelial cell monolayers were then exposed to hypoxia/reoxygenation alone and/or epinephrine or norepinephrine. Endothelial glycocalyx degradation was indexed as well as subsequent endothelial injury/activation. RESULTS Aged endothelial cells showed increase glycocalyx shedding and subsequent loss of glycocalyx thickness. This lead to a more pronounced level of EC injury/activation compared with young endothelial cells. Although exposure to biomimetic shock conditions exacerbated both endothelial glycocalyx shedding and endothelial injury in both aged and young endothelial cells, the effect was significantly more pronounced in aged cells. CONCLUSION Advanced age is associated with worse outcomes in severely injured trauma patients. Our study demonstrates that there is increased EG shedding and a diminished EG layer in aged compared to "young" endothelial cell layers. Biomimetic shock conditions lead to an even greater impairment of the endothelial glycocalyx in aged versus young endothelial cell monolayers. It appears that these effects are a consequence of aging related oxidative stress at both baseline and shock conditions. This exacerbates shock-induced endotheliopathy and may contribute to untoward effects on patient outcomes in this population.
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Affiliation(s)
- Michael J Carge
- From the Michael and Marian Ilitch Department of Surgery (M.J.C., D.M.L., L.N.D.), Wayne State University School of Medicine, Detroit, Michigan
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Pattern of trauma in elderly patients seen at the trauma centre of national hospital Abuja, Nigeria. Afr J Emerg Med 2021; 11:347-351. [PMID: 34367894 PMCID: PMC8327492 DOI: 10.1016/j.afjem.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/30/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The global population is aging, creating challenges for health systems. The mean age of patients with major trauma has increased over time, posing some challenges for trauma system designs. Elderly trauma patients are said to have higher mortality rates and longer hospital and intensive care unit stays. This study is aimed at assessing the pattern of injuries in elderly population in a dedicated trauma centre of a developing economy. Methods This is a retrospective study of all patients aged 60 years and above seen in the trauma centre of a West African tertiary hospital over a three year period from January 2017 to December 2019. Relevant parameters including Sociodemographic data, injury pattern and injury scores were derived from the trauma registry. Data analysis was done using statistical package for social sciences (SPSS) version 24. Results were presented using tables and a figure. Results A total of 183 patients aged 60 years and above were enrolled out of 4549 general trauma patients, representing 4% of the trauma patient population seen. Male to female ratio was 2.3 with the mean age of 65 ± 6.3. The most frequent mechanisms of injury were motor vehicular crash (MVC) (48.4%), followed by falls (16.5%). More proportion of females (21.8%) were significantly found to suffer falls compared to their males (14.2%) counterparts (p < 0.05). Traumatic brain injury was the commonest diagnosis accounting for 24.3% of cases. The predominant revised trauma scores (RTS) and injury severity scores (ISS) were 12 and 1–15 respectively, with overall mortality of 6.1%. Conclusion The proportion of elderly trauma patients studied in this centre is low. MVC is still the leading mechanism of injury in our elderly trauma population. The mortality rate is however low in this study, in line with the low trauma and severity scores. Preventive measures for MVC should be strongly encouraged to reduce the incidence of elderly trauma patients in this part of the world.
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Savioli G, Ceresa IF, Macedonio S, Gerosa S, Belliato M, Luzzi S, Lucifero AG, Manzoni F, Ricevuti G, Bressan MA. Major Trauma in Elderly Patients: Worse Mortality and Outcomes in an Italian Trauma Center. J Emerg Trauma Shock 2021; 14:98-103. [PMID: 34321808 PMCID: PMC8312913 DOI: 10.4103/jets.jets_55_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/24/2020] [Accepted: 01/04/2021] [Indexed: 01/24/2023] Open
Abstract
Introduction: Major trauma is the leading cause of mortality in the world in patients younger than 40 years. However, the proportion of elderly people who suffer trauma has increased significantly. The purpose of this study is to assess the correlation of old age with mortality and other unfavorable outcomes. Methods: We assessed on one hand, anatomical criteria such as ISS values and the number of body regions affected, on the other hand, hemodynamic instability criteria, various shock indices, and Glasgow Coma Scale. Finally, we also evaluated biochemical parameters, such as lactate, BE, and pH values. We conducted a prospective and monocentric observational study of all the patients referred to the Emergency Department of the IRCCS Fondazione Policlinico S. Matteo in Pavia for major trauma in 13 consecutive months: January 1, 2018–January 30, 2019. We compared the elderly population (>75 years) and the younger population (≤75). Results: We included 501 patients, among which 10% were over the age of 75 years. The mortality rate was higher among the older patients than among the younger (4% vs. 1.33%; P = 0.050). Hemodynamic instability was more common in the older patients than in the younger (26% vs. 9%; P < 0.001). More older patients (44%) had an ISS >16, in comparison with 32% of younger patients (P = 0.01). Conclusions: The elderly showed worse outcomes in terms of mortality, hospitalization rate, hemodynamic instability criteria, and anatomical and biochemical parameters.
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Affiliation(s)
- Gabriele Savioli
- Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Sarah Macedonio
- Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sebastiano Gerosa
- Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mirko Belliato
- Department of Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Federica Manzoni
- Department of Hygiene and Health Prevention, Health Promotion-Environmental Epidemiology Unit, Health Protection Agency, Pavia, Italy
| | - Giovanni Ricevuti
- Department of Drug Science, University of Pavia, Saint Camillus International University of Health Sciences, Rome, Italy
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del Río-Casanova L, Sánchez-Martín M, García-Dantas A, González-Vázquez A, Justo A. Psychological Responses According to Gender during the Early Stage of COVID-19 in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073731. [PMID: 33918378 PMCID: PMC8038227 DOI: 10.3390/ijerph18073731] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Current research has pointed out an increased risk of mental health problems during the COVID-19 pandemic in women compared to men, however the reason for this difference remains unclear. The aim of this research is to study early psychological responses to the pandemic in the Spanish general population, focusing on gender differences. METHODS Nine to 14 days after the declaration of a state of emergency an online survey was conducted assessing sociodemographic, health, behavioral and COVID-19-related variables. Mental health status was evaluated by the Depression, Anxiety and Stress Scale (DASS-21), the Impact of Event Scale-Revised (IES-R), and the Self-Care Scale (SCS). RESULTS The study included 3520 respondents: 2611 women and 909 men. Women scored significantly higher in DASS-21 and IES-R (p < 0.05) and were more likely to somatize, suffer from hypochondriasis, sleeping disturbances and claustrophobia (p < 0.05). Being a woman can be considered a risk factor for intrusive thoughts, avoidance mechanisms, stress and anxiety (Odd Ratio = 2.7/2.3/2.3/1.6). The risk of presenting posttraumatic symptoms and emotional distress was greater in women (Odd Ratio = 6.77/4.59). General linear models to predict IES-R and DASS-21 scores clarified which variables were gender specific, such as main concerns. CONCLUSIONS This study provides evidence that at early stages of the pandemic, women mental health was more impacted and that both genders show different concerns. Gender perspective in secondary and tertiary prevention strategies must be taken into account when facing the distress associated with the pandemic.
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Affiliation(s)
- Lucía del Río-Casanova
- Department of Psychiatry, University of Santiago de Compostela, Santiago de Compostela, 15705 Santiago de Compostela, Spain;
| | - Milagrosa Sánchez-Martín
- Department of Psychology, School of Social Sciences and Humanities, Universidad Loyola Andalucía, Dos Hermanas Campus, 41014 Sevilla, Spain; or
- Correspondence: ; Tel.: +34-955-641-600 (ext. 2489)
| | - Ana García-Dantas
- Department of Psychology, School of Social Sciences and Humanities, Universidad Loyola Andalucía, Dos Hermanas Campus, 41014 Sevilla, Spain; or
- Dantas Psicología Clínica (Private Therapy Clinic), 41011 Sevilla, Spain
| | - Anabel González-Vázquez
- A Coruña University Hospital, University of Santiago de Compostela, Santiago de Compostela, 15003 A Coruña, Spain;
| | - Ania Justo
- Imaya Medical Institute (Private Therapy Clinic), 36204 Vigo, Spain;
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Are There Any Red Flag Injuries in Severely Injured Patients in Older Age? J Clin Med 2021; 10:jcm10020185. [PMID: 33430174 PMCID: PMC7825590 DOI: 10.3390/jcm10020185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Severely injured elderly patients pose a significant burden to trauma centers and, compared with younger patients, have worse prognoses and higher mortality rates after major trauma. The objective of this study was to identify the etiological mechanisms that are associated with severe trauma in elderly patients and to detect which injuries correlate with high mortality in elderly patients. Methods: Using a prospect cohort study model over an 11-year period, severely injured patients (ISS ≥ 16) were divided into two age groups (Group 1: 18–64; Group 2: 65–99 years). A comparison of the groups was conducted regarding injury frequency, trauma mechanism, distribution of affected body parts (AIS and ISS regions) and injury related mortality. Results: In total, 1008 patient were included (Group 1: n = 771; Group 2: n = 237). The most relevant injury in elderly patients was falling from low heights (<3 m) in contrast to traffic accident in young patients. Severely injured patients in the older age group showed a significantly higher overall mortality rate compared to the younger group (37.6% vs. 11.7%; p = 0.000). In both groups, the 30-day survival for patients without head injuries was significantly better compared to patients with head injuries (92.7% vs. 85.3%; p = 0.017), especially analyzing elderly patients (86.6% vs. 58.6%; p = 0.003). The relative risk of 30-day mortality in patients who suffered a head injury was also higher in the elderly group (OR: Group 1: 4.905; Group 2: 7.132). Conclusion: In contrast to younger patients, falls from low heights (<3 m) are significant risk factors for severe injuries in the geriatric collective. Additionally, elderly patients with an ISS ≥ 16 had a significantly higher mortality rate compared to severe injured younger patients. Head injuries, even minor head traumata, are associated with a significant increase in mortality. These findings will contribute to the development of more age-related therapy strategies in severely injured patients.
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Hip fracture care during Covid-19: a regional trauma centre's experience. Ir J Med Sci 2021; 190:1275-1280. [PMID: 33392978 PMCID: PMC7779090 DOI: 10.1007/s11845-020-02476-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/14/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The Covid-19 pandemic has caused worldwide upheaval from early 2020. Trauma and orthopaedic services are no different. A fundamentally important and significant portion of trauma services is the treatment of fragility fractures of the proximal femur, otherwise known as hip fractures. The hip fracture "Blue book Standards", the key performance indicators (KPIs) associated with appropriate hip fracture care are challenging during non-crisis times. We aim to review Blue Book compliance during the Covid-19 crisis and review outcomes of hip fractures, including Covid-19 infection rates. METHODS We retrospectively reviewed IHFD data to collection demographic data, IHFD standards of care, 30-day mortality rates and complications between 23rd March and 20th May 2020 and 2019. Covid-19 rates in 2020 were also recorded. RESULTS A total of 36 hip fractures were recorded in 2020, compared with 45 in 2019, resulting in a 20% reduction in presentations. Thirty-day mortality in hip fractures during the Covid-19 crisis was 8.3% compared with 2.2% in 2020. Covid-19 infection was statistically associated with 30-day mortality in the 2020 cohort. Statistically significant improvements in time-dependent KPIs (time to ward and time to surgery) were noted in the 2020 cohort. CONCLUSIONS Despite improvements in hip fracture care KPIs, the Covid-19 crisis was associated with increased 30-day mortality in hip fracture patients. A positive Covid-19 swab was associated with higher mortality. These observations are of paramount importance to ensure adequate service planning and provision in the face of a potential "second wave" of Covid-19 infections leading into the winter months of 2020.
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Lumjeaksuwan M, Patcharasopit S, Seksanpanit C, Sritharo N, Aeampuck A, Wittayachamnankul B. The trend of emergency department visits among the elderly in Thailand. WHO South East Asia J Public Health 2021; 10:25-28. [PMID: 35046154 DOI: 10.4103/who-seajph.who-seajph_67_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Emergency department (ED) usage by older adults tends to be a major health issue due to increase in aging population and their health fragility. Currently, there is no study comparing ED data of older adults with those of younger population in Southeast Asia. The aim of this study was to explore the epidemiologic data of elderly who visited the ED from 2016 to 2018 and compare them with data from younger group. Data on ED visits from 2016 to 2018 were extracted from the electronic medical database. Descriptive statistics were used for analyzing the collected data and compared with the data of the age group of 15-59 years. A total of 27,871 elderly patients were found eligible and included. The mean age was 72.69 years (95% confidence interval 72.6-72.8). Patients aged 60-69 years have the highest ED visits rate (45.4%). From the total visits, 58.06% were discharged from ED, while 40.82% were admitted to hospital with 11.22% death rate after the admission. The most diagnosed condition was injury, poisoning, or other consequence from an external cause, with a head injury as the leading cause (20.74%). Compared with patients aged 15-59 years, elderly patients had a higher visit rate per 1000 population (21.99 vs. 30.91; P < 0.001), more admissions (15% vs. 40.8%; P < 0.001), and more re-visits within 7 days (1.81% vs. 4.07%; P < 0.001). These results showed that older adult patients tend to have higher ED visits rate, ED re-visits rate, and admissions rate compared to younger age groups.
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Affiliation(s)
- Methasit Lumjeaksuwan
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suparada Patcharasopit
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chanatip Seksanpanit
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Natchaya Sritharo
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Aeampuck
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Borwon Wittayachamnankul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Abstract
Fall represents an important cause of death and its relation with the population aging evidences the need of a broad analysis considering different aspects associated with its occurrence. The objective of this study was to compare fatal victims due to unintentional fall among adults, young olds, olds, and oldest olds, according to sociodemographic data, characteristics, and severity of the trauma. This study is a cross-sectional, comparative study analyzing autopsy reports of fatal victims due to fall, admitted to the Medical Legal Institute of Sao Paulo, Sao Paulo, Brazil, in 2015. The following age groups were: adults (≥18 and <60 years), young olds (≥60 and <70 years), olds (≥70 and <80 years), and oldest olds (≥80 years). The Pearson's χ, Fisher's exact, Kruskal-Wallis, and Dunn tests were applied to compare the groups, with a significance level of 5%. Regarding the 469 fatalities analyzed (57.8% males, mean age: 71.3 ± 18.2 years), there was a higher frequency of oldest olds (43.5%), ground-level falls (70.1%), femoral fractures (35.0%), and delayed deaths (79.6%) due to posttraumatic complications (57.2%). Adults, young olds, olds, and oldest olds differed significantly (p ≤ .005) in relation to the total of analyzed variables, with a special remark on the differences between the age extremes. High frequencies of femoral fractures and delayed deaths due to complications of treatment in low-severity fall victims, especially those older than 70 years, make it necessary to improve fall prevention programs in the older adults and to create a line of care for this population.
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Jiang L, Zheng Z, Zhang M. The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients. World J Emerg Surg 2020; 15:59. [PMID: 33076958 PMCID: PMC7574576 DOI: 10.1186/s13017-020-00340-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients. Methods Annual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level I trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated. Results The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE II, and SAPS II in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715, and 0.725, respectively. Conclusion The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.
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Affiliation(s)
- Libing Jiang
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang road 88, Hangzhou, China
| | - Zhongjun Zheng
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang road 88, Hangzhou, China
| | - Mao Zhang
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang road 88, Hangzhou, China.
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Sikander N, Ahmad T, Shaikh KA, Abid A, Mazcuri M, Nasreen S. Analysis of Injury Patterns and Outcomes of Blunt Thoracic Trauma in Elderly Patients. Cureus 2020; 12:e9974. [PMID: 32850270 PMCID: PMC7445091 DOI: 10.7759/cureus.9974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction In the elderly population, trauma is a leading cause of utilization of healthcare, institutionalization, disability, and mortality. In this study, we will assess the injury patterns and the factors associated with the outcomes of blunt thoracic trauma in elderly individuals. Methods This prospective observational study was conducted in the Department of Thoracic Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from September 2019 to April 2020. The study included patients of both genders aged 60 years and above with blunt thoracic trauma. Patients with concomitant neurological injuries and penetrating trauma to the chest were excluded. Results There were a total of 80 patients in this study; majority were males (n = 66 [82.5%]). The mean age was 70.18 ± 8.3 years. Road traffic accident was the most common mode of injury (n = 45 [56.3%]) followed by fall (n = 32 [40%]). Hemothorax and hemopneumothorax were the most common primary diagnosis. Rib fractures were encountered in 72 (90%) patients. Mortality rate was 21.3% (n = 17). Factors significantly related to mortality were age ≥ 80 years (p = 0.00), tension pneumothorax (p = 0.036), pre-existing cardiopulmonary disease (p = 0.032), blood loss ≥ 500 mL (p = 0.004), flail chest (p = 0.018), and chest trauma score ≥ 5 (p = 0.001). Mean hospital stay in our study was 5.3 ± 3.4 days. Factors lengthening hospital stay by more than five days included lung contusion (p = 0.02), more than two rib fractures (p = 0.004), hemopneumothorax (p = 0.026), pneumonia (p = 0.003), acute respiratory distress syndrome (p = 0.003), and flail chest (p = 0.013). Conclusions Elderly patients with blunt thoracic trauma have higher mortality. Proactive evaluation of injuries using the chest trauma score in the elderly population helps in recognizing patients at high risk of mortality and helps in the timely management to prevent adverse outcomes.
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Affiliation(s)
- Nazish Sikander
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Tanveer Ahmad
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Khalil A Shaikh
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Ambreen Abid
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Misauq Mazcuri
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Shagufta Nasreen
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Page PS, Josiah DT. Traumatic vertebral artery injuries in the geriatric population: a retrospective cohort study. J Neurosurg Spine 2020; 32:657-660. [PMID: 31952030 DOI: 10.3171/2019.11.spine191055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traumatic vertebral artery injuries (TVAIs) are a common finding in cervical spine trauma and can predispose patients to posterior circulation infarction. While extensive research has been conducted regarding the management and criteria for imaging in patients with suspected blunt vascular injury, little research has been conducted highlighting these injuries in the geriatric population. METHODS The authors performed a retrospective review of all patients evaluated at a level 1 trauma center and found to have TVAIs between January 1, 2010, and January 1, 2018. Biometric, clinical, and imaging data were obtained from a trauma registry database. Patients were divided into 2 groups on the basis of age, a geriatric group (age ≥ 65 years) and an adult group (age 18 to < 65 years). Variables evaluated included type of trauma, mortality, Injury Severity Score (ISS), and ICU length of stay. The Student t-test was used for continuous variables, and Pearson's chi-square test was used for categorical variables. RESULTS Of the 2698 of patients identified with traumatic cervical spine injuries, 103 patients demonstrated evidence of TVAI. Of these patients, 69 were < 65 and 34 were ≥ 65 years old at the time of their trauma. There was no difference in the incidence of TVAIs between the 2 groups. The ICU length of stay (4.71 vs 4.32 days, p > 0.05), hospital length of stay (10.71 vs 10.72 days, p > 0.05), and the ISS (21.50 vs 21.32, p > 0.05) did not differ significantly between the 2 groups. Mortality was significantly higher in the geriatric group, occurring in 9 of 34 patients (26.5%) compared with only 3 of 69 patients (4.4%) in the adult group (p < 0.001). Ground-level falls were the most common inciting event in the geriatric group (44% vs 14.5%, p < 0.001), whereas motor vehicle accidents were the most common etiology in the younger population (72.5% vs 38.2%, p < 0.001). Incidence of ischemic stroke did not vary significantly between the 2 groups (p > 0.05). CONCLUSIONS TVAI in the older adult population is associated with a significantly greater risk of mortality than in the younger adult population, despite the 2 groups having similar ISSs. Additionally, low-velocity mechanisms of injury, such as ground-level falls, are a greater risk factor for acquired TVAI in older adults than in younger adults, in whom it is a significantly less common etiology.
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Lepkowsky E, Simcox T, Rogoff H, Barzideh O, Islam S. Is There a Role for CT Pan-Scans in the Initial Workup of Fragility Fracture Patients? Geriatr Orthop Surg Rehabil 2020; 11:2151459320916937. [PMID: 32313714 PMCID: PMC7153176 DOI: 10.1177/2151459320916937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/09/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction: Computed tomography (CT) pan-scans have become increasingly commonplace as part of the initial diagnostic workup for patients sustaining traumatic injuries. They have proven effective in improving diagnostic accuracy in those with high-energy mechanisms of injury. However, the utility of pan-scans in the geriatric population sustaining low-energy traumatic injuries remains unproven. Methods: A retrospective review was conducted of patients who sustained a fragility fracture at a level-1 trauma center over a 15-month period. Radiologist interpretations of any CT pan-scans were reviewed for acute findings, and charts were reviewed for resulting changes in orthopedic and nonorthopedic management. Additionally, mechanism of injury, definitive management, time to surgery, length of stay, level of care at discharge, and demographic data were compared against similar patients who did not receive a pan-scan. Results: Of the 109 patients who underwent a CT pan-scan, 1 (0.92%) had a change in orthopedic treatment. Twelve (11.01%) patients had changes to their nonorthopedic management. In addition, 14 other patients had one or more consultations obtained based on pan-scan results that did not result in any change in management. Discussion: This study found that only 1 of the included patients had a change in orthopedic management and 12 had a change in nonorthopedic management, despite over half of the study population being found to have additional findings. Furthermore, patients who underwent a pan-scan did not have expedited surgical intervention or earlier discharges compared to those who were not pan-scanned. Conclusion: This study demonstrates whole-body CT imaging provides little benefit in geriatric patients who sustain fragility fractures and should be utilized judiciously and in a targeted fashion instead of as a routine part of trauma surgery or emergency department protocol in this patient population. Level of Evidence: Level III Retrospective Study.
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Affiliation(s)
- Eric Lepkowsky
- Department of Orthopedic Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Trevor Simcox
- Department of Orthopedic Surgery, NYU Winthrop Hospital, Mineola, NY, USA
| | - Hunter Rogoff
- Department of Orthopedic Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Omid Barzideh
- Department of Orthopedic Surgery, NYU Winthrop Hospital, Mineola, NY, USA
| | - Shahidul Islam
- Department of Orthopedic Surgery, NYU Winthrop Hospital, Mineola, NY, USA
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Krantz EN, Philpott CD, Droege ME, Mueller EW, Ernst NE, Garber PM, Tsuei BJ, Goodman MD, Droege CA. Retrospective Evaluation of Venous Thromboembolism Prophylaxis in Elderly, High-Risk Trauma Patients. J Surg Res 2020; 249:225-231. [PMID: 31991331 DOI: 10.1016/j.jss.2019.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) risk increases with age. Scarce data exist for patients age ≥65 y. This study evaluated VTE incidence in elderly, high-risk trauma patients receiving unfractionated heparin (UFH) or enoxaparin chemoprophylaxis. MATERIALS AND METHODS This retrospective, single-center, cohort study included trauma patients age ≥ 65 y with risk assessment profile (RAP) ≥ 5 who received UFH or enoxaparin chemoprophylaxis. The primary outcome was VTE incidence requiring therapeutic anticoagulation. An age-modified RAP (RAP-AM) was calculated as RAP without age distribution points. Logistic regression analyses were performed to identify independent predictors for VTE development and chemoprophylactic agent selection. Bleeding incidence compared packed red blood cells utilized. RESULTS A total of 1090 patients were included (UFH, n = 655; enoxaparin, n = 435). VTE occurred in 39 (3.6%) patients with no difference between groups in proximal deep vein thrombosis (2.1% versus 3.0%, P = 0.52) or pulmonary embolism (1.2% versus 1.4%, P = 0.96). Weight ≥125 kg (OR 4.12, 95% CI 1.06-16.11) and RAP-AM ≥ 5 (OR 6.52, 95% CI 2.65-16.03) were independently associated with VTE development. Increasing age (OR 1.04, 95% CI 1.03-1.06), initiation ≤ 24 h (OR 2.17, 95% CI 1.66-2.84) and creatinine clearance ≤ 30 mL/min (OR 1.61, 95% CI 1.17-2.21) were independent predictors of receiving UFH whereas increasing ISS (OR 0.97, 95% CI 0.95-0.99) was associated with receiving enoxaparin. CONCLUSIONS VTE incidence may be similar for high-risk, elderly trauma patients receiving UFH and enoxaparin chemoprophylaxis. Further research is necessary to determine noninferiority of UFH to enoxaparin in this patient population.
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Affiliation(s)
- Erica N Krantz
- UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio.
| | - Carolyn D Philpott
- UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Molly E Droege
- UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Eric W Mueller
- UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Neil E Ernst
- UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Paige M Garber
- UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Betty J Tsuei
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael D Goodman
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christopher A Droege
- UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
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Carrasco-Poyatos M, Ramos-Campo DJ, Rubio-Arias JA. Pilates versus resistance training on trunk strength and balance adaptations in older women: a randomized controlled trial. PeerJ 2019; 7:e7948. [PMID: 31741786 PMCID: PMC6859004 DOI: 10.7717/peerj.7948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/24/2019] [Indexed: 11/20/2022] Open
Abstract
Background The neuromuscular decline impact in the functional independence of older women is determining the necessity of implementing new strategies focused on core strength training and postural stability maintenance to promote healthy aging. Objectives To define whether Pilates or resistance training is better at improving (a) core isometric and isokinetic muscular strength, and (b) static and dynamic balance, in older women. Methods This was a cluster randomized controlled trial. Physically independent older women (60–80 years) from day centers were randomly allocated to Pilates, Muscular and Control Groups (PG, MG and CG) using a block randomization method. Only the research staff performing the assessment and statistical analysis were blinded. Exercise groups trained twice a week (1 h per session) for 18 weeks in a moderate-to-vigorous intensity. Core strength (primary outcome): trunk and hip isometric and hip isokinetic muscular strength (Biodex System III Pro Isokinetic Dynamometer), alongside one leg static balance (portable force platform Kistler 9286AA) and dynamic balance (timed up and go (TUG)) were assessed. Results A total of 60 participants were randomized (PG, n = 20; MG, n = 20; CG, n = 20) and 49 completed the trial (PG, n = 16; MG, n = 19; CG, n = 14). Regarding hip isometric extension strength, PG was statistically better than CG (P = 0.004). There were no differences between groups regarding isokinetic strength or balance. Intra-group comparisons showed significant improvements (P < 0.05) in the dynamic balance and trunk and hip isometric extension strength for PG and MG, whereas every hip isokinetic measurement was improved in MG. Exercise programs did not produce any adverse event. Conclusions The Pilates training program was more effective for improving isometric hip and trunk extension strength, while the Muscular training program generated greater benefits on trunk and hip isokinetic strength. Moreover, both training programs showed moderate effects for the TUG. Clinical Trial Registration The trial was registered at ClinicalTrials.gov (identifier: NCT02506491).
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Affiliation(s)
- María Carrasco-Poyatos
- Department of Education, Health and Public Administration Research Center, Universidad de Almería, Almería, Spain
| | - Domingo J Ramos-Campo
- Department of Physical Activity and Sport Sciences, UCAM Research Centre for High Performance Sport, Universidad Católica San Antonio, Murcia, Spain
| | - Jacobo A Rubio-Arias
- Department of Physical Activity and Sport Sciences, UCAM Research Centre for High Performance Sport, Universidad Católica San Antonio, Murcia, Spain
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45
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Saha S, DiRusso SM, Welle S, Lieberman B, Sender J, Shabsigh R, Baltazar GA. Integration of Geriatrician Consultation for Trauma Admissions May Benefit Patient Outcomes. Gerontol Geriatr Med 2019; 5:2333721419858735. [PMID: 31259206 PMCID: PMC6589989 DOI: 10.1177/2333721419858735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 11/16/2022] Open
Abstract
Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (–67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation and outcomes. Discussion: Geriatrician consultation is associated with optimized discharge disposition of trauma patients. We recommend geriatrician consultation for all geriatric trauma activations.
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Affiliation(s)
- Sumit Saha
- City University of New York, New York City, NY, USA
| | - Stephen M DiRusso
- City University of New York, New York City, NY, USA.,SBH Health System, Bronx, NY, USA
| | | | | | - Joel Sender
- City University of New York, New York City, NY, USA.,SBH Health System, Bronx, NY, USA
| | - Ridwan Shabsigh
- City University of New York, New York City, NY, USA.,SBH Health System, Bronx, NY, USA.,Cornell University, New York, NY, USA
| | - Gerard A Baltazar
- City University of New York, New York City, NY, USA.,SBH Health System, Bronx, NY, USA.,New York Institute of Technology, Old Westbury, NY, USA.,New York University Winthrop Hospital, Mineola, NY, USA
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46
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Abdi A, Soufinia A, Borji M, Tarjoman A. The Effect of Religion Intervention on Life Satisfaction and Depression in Elderly with Heart Failure. JOURNAL OF RELIGION AND HEALTH 2019; 58:823-832. [PMID: 30421268 DOI: 10.1007/s10943-018-0727-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The elderly suffering from heart failure is facing with some problems such as lowering of life satisfaction and depression. Regarding a lack of information in this issue, the current study was conducted to determine the effect of religion intervention on life satisfaction and depression in the elderly with heart failure, in Ilam-Iran. In a clinical trial study conducted on the elderly with heart failure disease in Ilam-Iran, the patients were randomly allocated into two experimental (46) and control (47) groups. The used instruments were a demographic checklist, life satisfaction questionnaire of LSI-Z and Beck depression inventory. The intervention done for test group was a religion-spiritual program designed based on the Richards and Bergin model, and according to Islam and Shia regulations and conducted during six sessions, each 30-45 min. The tools were completed before and after intervention. Gathered data were entered into SPSS software and analyzed by descriptive (mean and standard deviation) and inferential (independent t test and ANOVA) statistics. The results showed that there was no significant difference between the mean (SD) of life satisfaction in the experimental group [5.47 (3.37)] and control [5.85 (3.92)] before the intervention (P = 0.62) but after the intervention. The mean (SD) of life satisfaction of the test group [8.08 (4.36)] was higher than that of the control group [5.55 (3.96)] (P = 0.006). Also, no significant difference between the mean (SD) of depression in the experimental group [47.80 (10.48)] and control [49.87 (11.40)] before the intervention (P = 0.62) but after the intervention. The mean (SD) of depression of the test group [28.28 (14.78)] was lower than that of the control group [50.44 (14.02)] (P = 0.006). Regarding the positive effect of religion-spiritual program in depression and life satisfaction of the elderly with heart failure, it is suggested this program will be educated to these patients by health-care workers.
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Affiliation(s)
- Alireza Abdi
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Science, Kermanshah, Iran
- Nursing and Midwifery School, Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Askar Soufinia
- Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Milad Borji
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Science, Kermanshah, Iran.
- Nursing and Midwifery School, Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Asma Tarjoman
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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