Incidence trends of injury among the elderly in Spain, 2000–2010

Epidemiology, injury pattern and outcome of older trauma patients: A 15-year study of level-I trauma centers

BACKGROUND

Older adults have become a significant portion of the trauma population. Exploring their specificities is crucial to better meet their specific needs. The primary objective was to evaluate the temporal changes in the incidence, demographic and trauma characteristics, injury pattern, in-hospital admission, complications, and outcome of older trauma patients.

METHODS

A multicenter retrospective cohort study was conducted using the Quebec Trauma Registry. Patients aged ≥16 years admitted to one of the three adult level-I trauma centers between 2003 and 2017 were included. Descriptive analyses and trend-tests were performed to describe temporal changes.

RESULTS

A total of 53,324 patients were included, and 24,822 were aged ≥65 years. The median [IQR] age increased from 57[36-77] to 67[46-82] years, and the proportion of older adults rose from 41.8% in 2003 to 54.1% in 2017. Among those, falls remain the main mechanism (84.7%-88.3%), and the proportion of severe thorax (+8.9%), head (+8.7%), and spine (+5%) injuries significantly increased over time. The proportion of severely injured older patients almost doubled (17.6%-32.3%), yet their mortality decreased (-1.0%). Their average annual bed-days consumption also increased (+15,004 and +1,437 in non-intensive care wards and ICU, respectively).

CONCLUSIONS

Since 2014, older adults have represented the majority of admissions in Level-I trauma centers in Québec. Their bed-days consumption has greatly increased, and their injury pattern and severity have deeply evolved, while we showed a decrease in mortality.

Prevalence and Determinants of Self-Reported Injuries among Community-Dwelling Older Adults in the Philippines: A 10-Year Pooled Analysis

Injury among older adults is a serious health concern, but little information is known about it, particularly in developing countries. This study aimed to determine the prevalence of, and examine the socioeconomic, demographic, and health determinants of, self-reported injuries among older Filipinos. Using a pooled data of 21,316 community-dwelling residents aged 60 years or over from three waves of the Philippine National Demographic and Health Survey, multivariate logistic regression analyses were performed to assess the relationship between participants’ characteristics and reports of injuries. The total prevalence of self-reported injuries over a 10-year period was at 1.2%. Older adults with either government or private health insurance were more likely to report experiencing injuries (adjusted odds ratio (AOR) 1.55, 95% confidence interval (CI), 1.14–2.11), regardless of socio-demographic and economic status. In contrast, female older adults were found to be associated with a lower likelihood of self-reported injuries, after adjustment for other variables (AOR 0.69, 95% CI 0.53–0.88). Older adults who attained secondary education or higher also showed a lower likelihood of self-reported injuries (AOR 0.53, 95% CI 0.31–0.92). The proportion of older adults with injuries in the Philippines is still relatively low. However, preventive approaches with a special focus on gender, educational attainment, and health insurance status of older adults are warranted.

Accident Vulnerability and Vision for Action: A Pilot Investigation

Many accidents, such as those involving collisions or trips, appear to involve failures of vision, but the association between accident risk and vision as conventionally assessed is weak or absent. We addressed this conundrum by embracing the distinction inspired by neuroscientific research, between vision for perception and vision for action. A dual-process perspective predicts that accident vulnerability will be associated more strongly with vision for action than vision for perception. In this preliminary investigation, older and younger adults, with relatively high and relatively low self-reported accident vulnerability (Accident Proneness Questionnaire), completed three behavioural assessments targeting vision for perception (Freiburg Visual Acuity Test); vision for action (Vision for Action Test-VAT); and the ability to perform physical actions involving balance, walking and standing (Short Physical Performance Battery). Accident vulnerability was not associated with visual acuity or with performance of physical actions but was associated with VAT performance. VAT assesses the ability to link visual input with a specific action-launching a saccadic eye movement as rapidly as possible, in response to shapes presented in peripheral vision. The predictive relationship between VAT performance and accident vulnerability was independent of age, visual acuity and physical performance scores. Applied implications of these findings are considered.

Epidemiological overview - 18 years of ICU hospitalization due to trauma in Brazil

OBJECTIVE

Assess the magnitude and trend of hospitalization rates due to traumatic injuries in intensive care units (ICU) in Brazil from 1998 to 2015.

METHODS

This is an ecological time-series study that analyzed data from the Hospital Information System. A trend analysis of hospitalization rates was performed according to diagnosis, sex and age using generalized linear regression models and Prais-Winsten estimation.

RESULTS

Rates were higher among male patients, but increased hospitalization due to trauma among female patients influenced the ratio between both sexes. Falls and transport accidents were the most frequent causes of trauma. The average annual growth was 3.6% in ICU trauma hospitalization rates in Brazil, the highest growth was reported in the North region (8%; 95%CI 6.4-9.6), among women (5.4%; 95%CI 4.5-6.3), and among people aged 60 years and older (5.5%; 95%CI, 4.7-6.3). The most frequent causes of trauma are falls (4.5%; 95%CI 3.5-5.5) and care complications (5.4%; 95%CI 4.5-6.3). On the other hand, the annual hospital mortality rate due to trauma in ICU is 1.7% lower, on average (95%CI 2.1-1.3).

CONCLUSION

An increase in ICU hospitalization rate due to trauma in Brazil may be the result of some factors, such as an increasing number of accidents and cases of violence, the implementation of pre-hospital care, and improved access to care, with more beds in ICU. In addition, population aging is another factor, as a greater increase in hospitalization was observed among people aged 60 years and older.

Epidemiology of Road Traffic Injuries among Elderly People; A Systematic Review and Meta-Analysis

Objective:

To systematically review the epidemiological patterns and interventions for prevention of road traffic injuries (RTIs) among elderly.

Methods:

Searching keywords including: accident, trauma, road injury, road traffic injuries, aging, old, elder, strategy, intervention, road traffic crash prevention and traffic accident in databases including, Google scholar, SID, IranMedex, PubMed and Scopus. English and non-Persian articles, articles presented in congresses, articles that considered elderly people to have age under than 60 years were excluded. The reporting quality of articles was assessed by two experts using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) check list.

Results:

RTIs compromised 23.6% of total injuries among elderly. The most frequent injuries were about car accidents (51.4%). Pedestrian injuries composed 48.1% of the RTIs. Head and neck (32.1%) were most injured body parts. There was a significant difference between elderly and non-elderly people in terms of RTIs associated mortality (Odd=2.57 [1.2-5.4 CI 95%]). Overall 25 main domains of intervention and 73 subordinate domains were extracted in five categories (human, road and environment, tools and cars, medical, legal and political issues).

Conclusion:

According to the notable prevalence and fatality of RTIs, lack of sufficient studies and valid evidence of the present study can provide an appropriate evidence for better interventions for RTIs prevention among elderly.

Risk factors for 14-day rehospitalization following trauma with new traumatic spinal cord injury diagnosis: A 10-year nationwide study in Taiwan

Objectives

Fourteen-day rehospitalization with new traumatic spinal cord injury (tSCI) diagnosis is used as an indicator for the diagnostic quality of the first hospitalization. In this nationwide population-based cohort study, we identified risk factors for this indicator.

Methods

We conducted a nested case–control study by using the data of patients who received a first hospitalization for trauma between 2001 and 2011. The data were retrieved from Taiwan’s National Health Insurance Research Database. Variables including demographic and trauma characteristics were compared between patients diagnosed with tSCI at the first hospitalization and those receiving a 14-day rehospitalization with new tSCI diagnosis.

Results

Of the 23 617 tSCI patients, 997 had 14-day rehospitalization with new tSCI diagnosis (incidence rate, 4.22%). The risk of 14-day rehospitalization with new tSCI diagnosis was significantly lower in patients with severe (injury severity score [ISS] = 16–24; odds ratio [OR], 0.17; 95% confidence interval [CI], 0.13–0.21) and profound (ISS > 24; OR, 0.11; 95% CI, 0.07–0.18) injuries. Interhospital transfer (OR, 8.20; 95% CI, 6.48–10.38) was a significant risk factor, along with injuries at the thoracic (OR, 1.62; 95% CI, 1.21–2.18), lumbar (OR, 1.30; 95% CI, 1.02–1.65), and multiple (OR, 3.23; 95% CI, 1.86–5.61) levels. Brain (OR, 2.82), chest (OR, 2.99), and abdominal (OR, 2.74) injuries were also identified as risk factors. In addition, the risk was higher in patients treated at the orthopedic department (OR, 2.26; 95% CI, 1.78–2.87) and those of other surgical disciplines (OR, 1.89; 95% CI, 1.57–2.28) than in those treated at the neurosurgery department.

Conclusions

Delayed tSCI diagnoses are not uncommon, particularly among trauma patients with ISSs < 16 or those who are transferred from lower-level hospitals. Further validation and implementation of evidence-based decision rules is essential for improving the diagnostic quality of traumatic thoracolumbar SCI.

Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010

BACKGROUND

In recent years, the incidence of injury in older people has increased. The aim of this study is to address the hypothesis that this increase is due to an increase in the incidence of some injuries that, while less common than hip fractures, are sufficient jointly to counteract the decrease or stabilisation in hip fracture rates observed in most countries.

METHODS

We performed a descriptive study of trends using data from the National Hospital Discharge Register. We included individuals 65 years and older who were discharged from a Spanish hospital during the period 2000-2010 with at least one injury diagnosis in the primary diagnosis field on the discharge form. The dependent variables were the following injury groups, classified using the Barell Matrix: hip fracture, shoulder and upper arm fractures, forearm and elbow fractures, thoracic fractures, lower leg and ankle fractures, and TBI type 1 internal injury. Incidence rates were calculated per 100,000 inhabitants (data from National Statistics Institute) and stratified by sex and age group. Trends, in terms of Annual Percent Change (APC), were assessed using Poisson Regression with discharge year as the independent variable.

RESULTS

Hip fracture continues to be the most important injury type in older people. Thoracic fractures and TBI internal injuries are more common in men, while fractures in the upper extremities are more common in women. All injuries increased in frequency with age, except lower leg and ankle fractures, which decreased. While a secular decreasing trend in hip fracture was noted, the incidences of fractures of the shoulder and upper arm, forearm and elbow, and lower leg and ankle, as well as of TBI type 1 internal injuries have increased steadily.

CONCLUSIONS

Although hip fracture continue to be the most common type of injury in older people, this study has allowed identifying other types of injury that are becoming increasingly common. These trends are driving paradigm changes in the burden of injuries requiring treatment within the hospital system, and must be taken into account in the design of preventative programs and actions.