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Javier MA, Luque I, Mendez H, Yordán López N, Ramirez M, Morejón O, McKenney M. Morbidity and Mortality of Trauma Patients 55 and Older: A Study of Nontrauma Risk Factors. Am Surg 2024:31348241257470. [PMID: 38789105 DOI: 10.1177/00031348241257470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Introduction: The American College of Surgeons (ACS) recommends that special considerations be made during triage of trauma patients aged ≥55 due to an observed increase in morbidity and mortality in this population. The geriatric population aged ≥65 represents 30% of all trauma patients. Our objective was to assess which pre-existing conditions (PECs) are associated with worse outcomes in trauma patients aged ≥55. Methods: Study population was selected from the local trauma registry (2020-22). Bi-variate analysis compared PEC status with outcomes controlling for each Injury Severity Score (ISS) category. Injury Severity Score was defined as mild (1-8), moderate (9-15), severe (16-24), and critical (≥25). Results: A total of 5,168 patients were identified (54.9% female, 56.7% age ≥75, 49.1% mild injury). Patients who had chronic renal failure (CRF) were at increased odds of mortality after adjusting for mild (adjusted odds ratio [aOR]: 2.63), moderate (aOR: 2.97), severe (aOR: 2.84), and critical (aOR: 2.62) injuries. Patients who had cirrhosis or congestive heart failure (CHF) were at increased odds of mortality after adjusting for mild (aOR: 3.03, 1.61), moderate (aOR: 3.63, 2.14), and severe (aOR: 3.46, 1.93) injuries, respectively. In addition, there was a relationship between having chronic obstructive pulmonary disease (COPD), dementia, anticoagulant therapy, or diabetes with unplanned intensive care unit (ICU) admission and development of acute kidney injury (AKI). Discussion: There is an association between certain pre-exiting conditions and worse outcomes. Early identification of these factors could provide a foundation for better interdisciplinary management, prevention of complications and associated mortality.
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Affiliation(s)
- Mariel A Javier
- HCA Florida Kendall Hospital Trauma and Acute Care Surgery, Miami, FL, USA
| | - Ilko Luque
- HCA Florida Kendall Hospital Trauma and Acute Care Surgery, Miami, FL, USA
| | - Hector Mendez
- HCA Florida Kendall Hospital Trauma and Acute Care Surgery, Miami, FL, USA
| | | | - Marcela Ramirez
- HCA Florida Kendall Hospital Trauma and Acute Care Surgery, Miami, FL, USA
- HCA Florida Kendall Hospital Surgical Critical Care, Miami, FL, USA
| | - Orlando Morejón
- HCA Florida Kendall Hospital Trauma and Acute Care Surgery, Miami, FL, USA
- HCA Florida Kendall Hospital Surgical Critical Care, Miami, FL, USA
| | - Mark McKenney
- HCA Florida Kendall Hospital Trauma and Acute Care Surgery, Miami, FL, USA
- HCA Florida Kendall Hospital Surgical Critical Care, Miami, FL, USA
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Cho OH, Yoon J. Epidemiology of Accidental Injuries at Home and Related Risk Factors for Mortality among Older Adults in South Korea: A Retrospective Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:593. [PMID: 38674239 PMCID: PMC11052254 DOI: 10.3390/medicina60040593] [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] [Received: 03/11/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Accidental home injuries among older adults are increasing globally, but reporting is limited. This study aims to establish foundational data for program development and policies to prevent accidental injuries at home in older adults by using data on the occurrence of accidental injuries at home and analyzing the risk factors of mortality due to accidental injuries among adults aged 65 years and older. Materials and Methods: This retrospective study used data from the community-based Severe Trauma Survey in South Korea. This study identified general, injury-related, and treatment-related characteristics of older adults who were transported to the emergency department with accidental injuries at home. Single-variable and multiple logistic regression analyses were used to identify risk factors for mortality after injury. Results: The majority of older adults in this study who experienced accidental injuries at home were aged 75 to 84 (42.8%) and female (52.8%), with 1465 injured from falls and slips (68.0%). Risk factors for mortality included older age (≥85 years) (ORs 2.25, 95% CI 1.47-3.45), male sex (ORs 1.60, 95% CI 1.15-2.20), mechanism of injury (falls or slips vs. contact injury, ORs 6.76, 95% CI 3.39-13.47; airway obstruction vs. contact injury, ORs 13.96, 95% CI 6.35-30.71), higher severity (moderate vs. mild, ORs 2.56, 95% CI 1.45-4.54; severe vs. mild, ORs 12.24, 95% CI 6.48-23.12; very severe vs. mild, ORs 67.95, 95% CI 38.86-118.81), and receiving a blood transfusion (ORs 2.14, 95% CI 1.24-3.67). Conclusions: Based on these findings, the home and community environments where older adults live should be inspected and monitored, and in-home accidental injury prevention strategies should be developed tailored to the characteristics of older adults' risk factors and their injury-related characteristics.
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Affiliation(s)
- Ok-Hee Cho
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju 32588, Republic of Korea;
| | - Jeongeun Yoon
- Department of Nursing, Kunsan College of Nursing, Gunsan 54068, Republic of Korea
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3
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Gauss T, de Jongh M, Maegele M, Cole E, Bouzat P. Trauma systems in high socioeconomic index countries in 2050. Crit Care 2024; 28:84. [PMID: 38493142 PMCID: PMC10943799 DOI: 10.1186/s13054-024-04863-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: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
Considerable political, structural, environmental and epidemiological change will affect high socioeconomic index (SDI) countries over the next 25 years. These changes will impact healthcare provision and consequently trauma systems. This review attempts to anticipate the potential impact on trauma systems and how they could adapt to meet the changing priorities. The first section describes possible epidemiological trajectories. A second section exposes existing governance and funding challenges, how these can be met, and the need to incorporate data and information science into a learning and adaptive trauma system. The last section suggests an international harmonization of trauma education to improve care standards, optimize immediate and long-term patient needs and enhance disaster preparedness and crisis resilience. By demonstrating their capacity for adaptation, trauma systems can play a leading role in the transformation of care systems to tackle future health challenges.
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Affiliation(s)
- Tobias Gauss
- Division Anesthesia and Critical Care, University Hospital Grenoble Alpes, Grenoble, France.
- Grenoble Institute for Neurosciences, Inserm, U1216, Grenoble Alpes University, Grenoble, France.
| | - Mariska de Jongh
- Network Emergency Care Brabant (NAZB), ETZ Hospital, Tilburg, The Netherlands
| | - Marc Maegele
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University Witten-Herdecke, Cologne, Germany
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Pierre Bouzat
- Division Anesthesia and Critical Care, University Hospital Grenoble Alpes, Grenoble, France
- Grenoble Institute for Neurosciences, Inserm, U1216, Grenoble Alpes University, Grenoble, France
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McArdle M. Trauma in the elderly: a bilateral rectus sheath haematoma. BMJ Case Rep 2023; 16:e256061. [PMID: 38061846 PMCID: PMC10711929 DOI: 10.1136/bcr-2023-256061] [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: 12/18/2023] Open
Abstract
Life expectancy has more than doubled in the last century, and a new cohort of elderly and increasingly frail patients is presenting to emergency departments with new clinical challenges. When this patient cohort presents after injury, all aspects of clinical practice have to be recalibrated to provide safe and appropriate care. The prevalence of chronic disease, levels of organ failure, multiple comorbidities, greater use of anticoagulation and incidence of recurrent low- and high-impact trauma may delay and obscure diagnosis and, ultimately, increase mortality.Older age is a risk factor for rectus sheath haematoma (RSH), which is haemorrhage into the potential space surrounding the rectus abdominis muscle/s. It is a rare presentation following trauma but can provide diagnostic challenges and be fatal. Even more rare is bilateral RSH with only 12 reported in the literature since 1981.This case report describes bilateral RSH presenting in an elderly woman following a fall and the consequences of seemingly minor trauma in the elderly.
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Affiliation(s)
- Michael McArdle
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- South Warwickshire University NHS Foundation Trust, Warwick, UK
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5
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McNamara SL, Seo BR, Freedman BR, Roloson EB, Alvarez JT, O'Neill CT, Vandenburgh HH, Walsh CJ, Mooney DJ. Anti-inflammatory therapy enables robot-actuated regeneration of aged muscle. Sci Robot 2023; 8:eadd9369. [PMID: 36947599 DOI: 10.1126/scirobotics.add9369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Robot-actuated mechanical loading (ML)-based therapies ("mechanotherapies") can promote regeneration after severe skeletal muscle injury, but the effectiveness of such approaches during aging is unknown and may be influenced by age-associated decline in the healing capacity of skeletal muscle. To address this knowledge gap, this work used a noninvasive, load-controlled robotic device to impose highly defined tissue stresses to evaluate the age dependence of ML on muscle repair after injury. The response of injured muscle to robot-actuated cyclic compressive loading was found to be age sensitive, revealing not only a lack of reparative benefit of ML on injured aged muscles but also exacerbation of tissue inflammation. ML alone also disrupted the normal regenerative processes of aged muscle stem cells. However, these negative effects could be reversed by introducing anti-inflammatory therapy alongside ML application, leading to enhanced skeletal muscle regeneration even in aged mice.
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Affiliation(s)
- S L McNamara
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - B R Seo
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - B R Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - E B Roloson
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - J T Alvarez
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - C T O'Neill
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - H H Vandenburgh
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, USA
| | - C J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - D J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
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Case volume and rate are associated with outcomes in geriatric trauma: A case for geriatric trauma centers? J Trauma Acute Care Surg 2023; 94:241-247. [PMID: 36399493 DOI: 10.1097/ta.0000000000003838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Increased morbidity and mortality in geriatric trauma patients are usually due to decreased physiologic reserve and increased comorbidities. It is unclear whether geriatric trauma case volume and rates correlate with survival. We hypothesized that geriatric patients would have increased survival when treated in high-case volume and rate trauma centers. METHODS A retrospective cohort study was conducted using the Trauma Quality Improvement Program database between 2015 and 2019. Geriatric trauma patients (≥65 years) with severe injury (Injury Severity Score ≥16) were included. Geriatric case volume (GCV) was defined as the mean annual number of treated geriatric trauma patients, while geriatric case rate (GCR) was the mean annual number of elderly trauma patients divided by all trauma patients in each center. Trauma centers were classified into low-, medium-, and high-volume and rate facilities based on GCV and GCR. The association of GCV and GCR with in-hospital mortality and complication rates was assessed using the generalized additive model (GAM) and multivariate generalized linear mixed model adjusted for patient characteristics (age, sex, Injury Severity Score, Revised Trauma Score, and Modified Frailty Index) as fixed-effect variables and hospital characteristics as random effect variables. RESULTS A total of 164,818 geriatric trauma patients from 812 hospitals were included in the analysis. The GAM plots showed that the adjusted odds of in-hospital mortality decreased as GCV and the GCR increased. The generalized linear mixed model revealed that both high GCV and high GCR hospitals had lower mortality rates than low GCV and GCR hospitals (adjusted odds ratio [95% confidence interval], high GCV and high GCR centers; 0.82 [0.72-0.92] and 0.81 [0.73-0.90], respectively). CONCLUSION Both high geriatric trauma volume and rates were associated with decreased mortality of geriatric trauma patients. Consolidation of care for elderly patients with severe injury in specialized high-volume centers may be considered. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Ringen AH, Baksaas-Aasen K, Skaga NO, Wisborg T, Gaarder C, Naess PA. Close to zero preventable in-hospital deaths in pediatric trauma patients - An observational study from a major Scandinavian trauma center. Injury 2023; 54:183-188. [PMID: 35961867 DOI: 10.1016/j.injury.2022.07.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND In line with international trends, initial treatment of trauma patients has changed substantially over the last two decades. Although trauma is the leading cause of death and disability in children globally, in-hospital pediatric trauma related mortality is expected to be low in a mature trauma system. To evaluate the performance of a major Scandinavian trauma center we assessed treatment strategies and outcomes in all pediatric trauma patients over a 16-year period. METHODS A retrospective cohort study of all trauma patients under the age of 18 years admitted to a single institution from 1st of January 2003 to 31st of December 2018. Outcomes for two time periods were compared, 2003-2009 (Period 1; P1) and 2010-2018 (Period 2; P2). Deaths were further analyzed for preventability by the institutional trauma Mortality and Morbidity panel. RESULTS The study cohort consisted of 3939 patients. A total of 57 patients died resulting in a crude mortality of 1.4%, nearly one quarter of the study cohort (22.6%) was severely injured (Injury Severity Score > 15) and mortality in this group decreased from 9.7% in P1 to 4.1% in P2 (p<0.001). The main cause of death was brain injury in both periods, and 55 of 57 deaths were deemed non-preventable. The rate of emergency surgical procedures performed in the emergency department (ED) decreased during the study period. None of the 11 ED thoracotomies in non-survivors were performed after 2013. CONCLUSION A dedicated multidisciplinary trauma service with ongoing quality improvement efforts secured a low in-hospital mortality among severely injured children and a decrease in futile care. Deaths were shown to be almost exclusively non-preventable, pointing to the necessity of prioritizing prevention strategies to further decrease pediatric trauma related mortality.
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Affiliation(s)
- Amund Hovengen Ringen
- Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway; Department of Anesthesia, Oslo University Hospital Ullevaal, PB 4950 Nydalen, Oslo 0424, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Kjersti Baksaas-Aasen
- Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway; Department of Anesthesia, Oslo University Hospital Ullevaal, PB 4950 Nydalen, Oslo 0424, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anesthesia, Oslo University Hospital Ullevaal, PB 4950 Nydalen, Oslo 0424, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Torben Wisborg
- University of Tromsø, The Arctic University of Norway, Hammerfest, Norway; Department of Anesthesia and Intensive Care, Finnmark Health trust, Hammerfest Hospital, Hammerfest, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Paal Aksel Naess
- Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Differences in time-critical interventions and radiological examinations between adult and older trauma patients: A national register-based study. J Trauma Acute Care Surg 2022; 93:503-512. [PMID: 35137729 PMCID: PMC9488941 DOI: 10.1097/ta.0000000000003570] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Older trauma patients are reported to receive lower levels of care than younger adults. Differences in clinical management between adult and older trauma patients hold important information about potential trauma system improvement targets. The aim of this study was to compare prehospital and early in-hospital management of adult and older trauma patients, focusing on time-critical interventions and radiological examinations. METHODS Retrospective analysis of the Norwegian Trauma Registry for 2015 through 2018. Trauma patients 16 years or older met by a trauma team and with New Injury Severity Score of 9 or greater were included, dichotomized into age groups 16 years to 64 years and 65 years or older. Prehospital and emergency department clinical management, advanced airway management, chest decompression, and admission radiological examinations was compared between groups applying descriptive statistics and appropriate statistical tests. RESULTS There were 9543 patients included, of which 28% (n = 2711) were 65 years or older. Older patients, irrespective of injury severity, were less likely attended by a prehospital doctor/paramedic team (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.57-0.71), conveyed by air ambulance (OR, 0.65; 95% CI, 0.58-0.73), and transported directly to a trauma center (OR, 0.86; 95% CI, 0.79-0.94). Time-critical intervention and primary survey radiological examination rates only differed between age groups among patients with New Injury Severity Score of 25 or greater, showing lower rates for older adults (advanced airway management: OR, 0.60; 95% CI, 0.47-0.76; chest decompression: OR, 0.46; 95% CI, 0.25-0.85; x-ray chest: OR, 0.54; 95% CI, 0.39-0.75; x-ray pelvis: OR, 0.69; 95% CI, 0.57-0.84). However, for the patients attended by a doctor/paramedic team, there were no management differences between age groups. CONCLUSION Older trauma patients were less likely to receive advanced prehospital care compared with younger adults. Older patients with very severe injuries received fewer time-critical interventions and radiological examinations. Improved dispatch of doctor/paramedic teams to older adults and assessment of the impact the observed differences have on outcome are future research priorities. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Differences in characteristics between patients ≥ 65 and < 65 years of age with orthopaedic injuries after severe trauma. Scand J Trauma Resusc Emerg Med 2022; 30:51. [PMID: 36153545 PMCID: PMC9509558 DOI: 10.1186/s13049-022-01038-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Aim
Many trauma patients have associated orthopaedic injuries at admission. The existing literature regarding orthopaedic trauma often focuses on single injuries, but there is a paucity of information that gives an overview of this group of patients. Our aim was to describe the differences in characteristics between polytrauma patients ≥ 65 and < 65 years of age suffering orthopaedic injuries.
Methods
Patients registered in the Norwegian Trauma Registry (NTR) with an injury severity score (ISS) > 15 and orthopaedic injuries, who were admitted to Haukeland University Hospital in 2016–2018, were included. Data retrieved from the patients’ hospital records and NTR were analysed. The patients were divided into two groups based on age.
Results
The study comprised 175 patients, of which 128 (73%) and 47 (27%) were aged < 65 (Group 1) and ≥ 65 years (Group 2), respectively. The ISS and the new injury severity score (NISS) were similar in both groups. The dominating injury mechanism was traffic-related and thoracic injury was the most common location of main injury in both groups. The groups suffered a similar number of orthopaedic injuries. A significantly higher proportion of Group 1 underwent operative treatment for their orthopaedic injuries than in Group 2 (74% vs. 53%). The mortality in Group 2 was significantly higher than that in Group 1 (15% vs. 3%). In Group 2 most deaths were related to traffic injuries (71%). High energy falls and traffic-related incidents caused the same number of deaths in Group 1. In Group 1 abdominal injuries resulted in most deaths, while head injuries was the primary reason for deaths in Group 2.
Conclusions
Although the ISS and NISS were similar, mortality was significantly higher among patients aged ≥ 65 years compared to patients < 65 years of age. The younger age group underwent more frequently surgery for orthopaedic injuries than the elderly. There may be multiple reasons for this difference, but our study does not have sufficient data to draw any conclusions. Future studies may provide a deeper understanding of what causes treatment variation between age groups, which would hopefully help to further develop strategies to improve outcome for the elderly polytrauma patient.
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Flaaten N, Dyke G. First rib fracture: Still a marker of trauma severity? Emerg Med Australas 2022; 34:808-811. [PMID: 35445531 DOI: 10.1111/1742-6723.13983] [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: 09/03/2021] [Revised: 03/27/2022] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE First rib fractures (FRFs) have historically been a marker for severe trauma and poor outcomes. The aim of the present study was to assess whether an association still exists between a fractured first rib and global trauma scores suffered by the patient, examine mortality rates and identify other commonly associated injuries. METHODS This retrospective study examined records collected from patients from the Rockhampton Hospital with a traumatic FRF from July 2015 to June 2020. Patient demographics, mortality rate and injuries sustained were compiled. The Injury Severity Score (ISS) was utilised and calculated for each patient. Analysis was conducted to determine associations between trauma scores and FRFs. RESULTS In total, 545 patients had a rib fracture with 48 patients identified as having an FRF. Median age was 50 years. Thirty-seven (77%) were male. The most common mechanism of FRF was motor vehicle/motorbike accidents (71%). Fifty percent of patients with an observed FRF had the highest global ISS of very severe, with 13% severe, 22% moderate and 15% mild. No patients died from their injuries. Of those with an FRF, 79% experienced fractures other than ribs, 75% had other rib fractures and 52% had chest injuries. CONCLUSIONS A larger than expected proportion of FRFs were not associated with severe trauma scores or high mortality. These findings suggest that patients with an FRF may have a greater chance of surviving their traumatic FRF than previously reported. Clinicians should be aware of the potential for severity and specific associated injuries when treating a patient with FRFs.
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Affiliation(s)
- Nordan Flaaten
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Garry Dyke
- Department of Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia
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11
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Tonkins M, Bradbury D, Bramley P, Sabir L, Wilkinson A, Lecky F. Care of the older trauma patient following low-energy transfer trauma-highlighting a research void. Age Ageing 2022; 51:6561969. [PMID: 35380606 DOI: 10.1093/ageing/afac074] [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: 10/07/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND in high-income countries trauma patients are becoming older, more likely to have comorbidities, and are being injured by low-energy mechanisms. This systematic review investigates the association between higher-level trauma centre care and outcomes of adult patients who were admitted to hospital due to injuries sustained following low-energy trauma. METHODS a systematic review was conducted in January 2021. Studies were eligible if they reported outcomes in adults admitted to hospital due to low-energy trauma. In the presence of study heterogeneity, a narrative synthesis was pre-specified. RESULTS three studies were included from 2,898 unique records. The studies' risk of bias was moderate-to-serious. All studies compared outcomes in trauma centres verified by the American College of Surgeons in the USA. The mean/median ages of patients in the studies were 73.4, 74.5 and 80 years. The studies reported divergent results. One demonstrated improved outcomes in level 3 or 4 trauma centres (Observed: Expected Mortality 0.973, 95% CI: 0.971-0.975), one demonstrated improved outcomes in level 1 trauma centres (Adjusted Odds Ratio 0.71, 95% CI: 0.56-0.91), and one demonstrated no difference between level 1 or 2 and level 3 or 4 trauma centre care (adjusted odds ratio 0.91, 95% CI: 0.80-1.04). CONCLUSIONS the few relevant studies identified provided discordant evidence for the value of major trauma centre care following low-energy trauma. The main implication of this review is the paucity of high-quality research into the optimum care of patients injured in low-energy trauma. Further studies into triage, interventions and research methodology are required.
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Affiliation(s)
- Michael Tonkins
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Paul Bramley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lisa Sabir
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Anna Wilkinson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Fiona Lecky
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Chow J, Kuza CM. Predicting mortality in elderly trauma patients: a review of the current literature. Curr Opin Anaesthesiol 2022; 35:160-165. [PMID: 35025820 DOI: 10.1097/aco.0000000000001092] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Advances in medical care allow patients to live longer, translating into a larger geriatric patient population. Adverse outcomes increase with older age, regardless of injury severity. Age, comorbidities, and physiologic deterioration have been associated with the increased mortality seen in geriatric trauma patients. As such, outcome prediction models are critical to guide clinical decision making and goals of care discussions for this population. The purpose of this review was to evaluate the various outcome prediction models for geriatric trauma patients. RECENT FINDINGS There are several prediction models used for predicting mortality in elderly trauma patients. The Geriatric Trauma Outcome Score (GTOS) is a validated and accurate predictor of mortality in geriatric trauma patients and performs equally if not better to traditional scores such as the Trauma and Injury Severity Score. However, studies recommend medical comorbidities be included in outcome prediction models for geriatric patients to further improve performance. SUMMARY The ideal outcome prediction model for geriatric trauma patients has not been identified. The GTOS demonstrates accurate predictive ability in elderly trauma patients. The addition of medical comorbidities as a variable in outcome prediction tools may result in superior performance; however, additional research is warranted.
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Affiliation(s)
- Jarva Chow
- Department of Anesthesiology and Critical Care, University of Chicago, Chicago, Illinois
| | - Catherine M Kuza
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Maughan BC, Lin A, Caughey AB, Bulger EM, McConnell KJ, Malveau S, Griffiths D, Newgard CD. Field Trauma Triage among Older Adults: A Cost-Effectiveness Analysis. J Am Coll Surg 2022; 234:139-154. [PMID: 35213435 DOI: 10.1097/xcs.0000000000000025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND National guidelines for prehospital trauma triage aim to identify seriously injured patients who may benefit from transport to trauma centers. These guidelines have poor sensitivity for serious injury among older adults. We evaluated the cost-effectiveness of a high-sensitivity triage strategy for older adults. STUDY DESIGN We developed a Markov chain Monte Carlo microsimulation model to estimate the cost-effectiveness of high-sensitivity field triage criteria among older adults compared with current practice. The model used a retrospective cohort of 3621 community-dwelling Medicare beneficiaries who were transported by emergency medical services after an acute injury in 7 counties in the northwestern US during January to December 2011. These data informed model estimates of emergency medical services triage assessment, hospital transport patterns, and outcomes from index hospitalization up to 1 year after discharge. Outcomes beyond 1 year were modeled using published literature. Differences in cost and quality-adjusted life years (QALYs) were calculated for both strategies using a lifetime analytical horizon. We calculated the incremental cost-effectiveness ratio (cost per QALY gained) to assess cost-effectiveness, which we defined using a threshold of less than $100,000 per QALY. RESULTS High-sensitivity trauma field triage for older adults would produce a small incremental benefit in average trauma system effectiveness (0.0003 QALY) per patient at a cost of $1,236,295 per QALY. Sensitivity analysis indicates that the cost of initial hospitalization and emergency medical services adherence to triage status (ie transporting triage-positive patients to a trauma center) had the largest influence on overall cost-effectiveness. CONCLUSIONS High-sensitivity trauma field triage is not cost-effective among older adults.
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Affiliation(s)
- Brandon C Maughan
- From the Center for Policy and Research in Emergency Medicine (Maughan, Lin, Malveau, Griffiths, Newgard), Oregon Health & Science University, Portland, OR
| | - Amber Lin
- From the Center for Policy and Research in Emergency Medicine (Maughan, Lin, Malveau, Griffiths, Newgard), Oregon Health & Science University, Portland, OR
| | - Aaron B Caughey
- Department of Emergency Medicine, and Department of Obstetrics and Gynecology (Caughey), Oregon Health & Science University, Portland, OR
| | - Eileen M Bulger
- the Department of Surgery, University of Washington, Seattle, WA (Bulger)
| | - K John McConnell
- Center for Health Systems Effectiveness (McConnell), Oregon Health & Science University, Portland, OR
| | - Susan Malveau
- From the Center for Policy and Research in Emergency Medicine (Maughan, Lin, Malveau, Griffiths, Newgard), Oregon Health & Science University, Portland, OR
| | - Denise Griffiths
- From the Center for Policy and Research in Emergency Medicine (Maughan, Lin, Malveau, Griffiths, Newgard), Oregon Health & Science University, Portland, OR
| | - Craig D Newgard
- From the Center for Policy and Research in Emergency Medicine (Maughan, Lin, Malveau, Griffiths, Newgard), Oregon Health & Science University, Portland, OR
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Karam BS, Patnaik R, Murphy P, deRoon-Cassini TA, Trevino C, Hemmila MR, Haines K, Puzio TJ, Charles A, Tignanelli C, Morris R. Improving mortality in older adult trauma patients: Are we doing better? J Trauma Acute Care Surg 2022; 92:413-421. [PMID: 34554138 DOI: 10.1097/ta.0000000000003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Older adult trauma is associated with high morbidity and mortality. Individuals older than 65 years are expected to make up more than 21% of the total population and almost 39% of trauma admissions by 2050. Our objective was to perform a national review of older adult trauma mortality and identify associated risk factors to highlight potential areas for improvement in quality of care. MATERIALS AND METHODS This is a retrospective cohort study of the National Trauma Data Bank including all patients age ≥65 years with at least one International Classification of Diseases, Ninth Revision, Clinical Modification trauma code admitted to a Level I or II US trauma center between 2007 and 2015. Variables examined included demographics, comorbidities, emergency department vitals, injury characteristics, and trauma center characteristics. Multilevel mixed-effect logistic regression was performed to identify independent risk factors of in-hospital mortality. RESULTS There were 1,492,759 patients included in this study. The number of older adult trauma patients increased from 88,056 in 2007 to 158,929 in 2015 (p > 0.001). Adjusted in-hospital mortality decreased in 2014 to 2015 (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.86-0.91) when compared with 2007 to 2009. Admission to a university hospital was protective (OR, 0.83; 95% CI, 0.74-0.93) as compared with a community hospital admission. There was no difference in mortality risk between Level II and Level I admission (OR, 1.00; 95% CI, 0.92-1.08). The strongest trauma-related risk factor for in-patient mortality was pancreas/bowel injury (OR, 2.25; 95% CI, 2.04-2.49). CONCLUSION Mortality in older trauma patients is decreasing over time, indicating an improvement in the quality of trauma care. The outcomes of university based hospitals can be used as national benchmarks to guide quality metrics. LEVEL OF EVIDENCE Therapeutic/Care Management, Level IV.
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Affiliation(s)
- Basil S Karam
- From the Department of Surgery (B.S.K., R.P., P.M., T.A.d.-C., Co.T., R.M.), Comprehensive Injury Center (T.A.d.-C.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (M.R.H.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (K.H.), Duke University, Durham, North Carolina; Department of Surgery (T.J.P.), University of Texas Health Science Center, Houston, Texas; Department of Surgery (A.C.), School of Public Health (A.C.), University of North Carolina, Chapel Hill, North Carolina; Department of Surgery (Ch.T.), Institute for Health Informatics (Ch.T.), University of Minnesota, Minneapolis; and Department of Surgery (Ch.T.), North Memorial Health Hospital, Robbinsdale, Minnesota
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15
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Stonko DP, Etchill EW, Giuliano KA, DiBrito SR, Eisenson D, Heinrichs T, Morrison JJ, Haut ER, Kent AJ. Failure to Rescue in Geriatric Trauma: The Impact of Any Complication Increases with Age and Injury Severity in Elderly Trauma Patients. Am Surg 2021; 87:1760-1765. [PMID: 34727744 DOI: 10.1177/00031348211054072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The interaction of increasing age, Injury Severity Score (ISS), and complications is not well described in geriatric trauma patients. We hypothesized that failure to rescue rate from any complication worsens with age and injury severity. METHODS The National Trauma Data Bank (NTDB) was queried for injured patients aged 65 years or older from January 1, 2013 through December 31, 2016. Demographics and injury characteristics were used to compare groups. Mortality rates were calculated across subgroups of age and ISS, and captured with heatmaps. Multivariable logistic regression was performed to identify independent predictors of mortality. RESULTS 614,496 geriatric trauma patients were included; 151,880 (24.7%) experienced a complication. Those with complications tended to be older, female, non-white, have non-blunt mechanism, higher ISS, and hypotension on arrival. Overall mortality was highest (19%) in the oldest (≥86 years old) and most severely injured (ISS ≥ 25) patients, with constant age increasing across each ISS group was associated with a 157% increase in overall mortality (P < .001, 95% CI: 148-167%). Holding ISS stable, increasing age group was associated with a 48% increase in overall mortality (P < .001, 95% CI: 44-52%). After controlling for standard demographic variables at presentation, the existence of any complication was an independent predictor of overall mortality in geriatric patients (OR: 2.3; 95% CI: 2.2-2.4). CONCLUSIONS Any complication was an independent risk factor for mortality, and scaled with increasing age and ISS in geriatric patients. Differences in failure to rescue between populations may reflect critical differences in physiologic vulnerability that could represent targets for interventions.
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Affiliation(s)
- David P Stonko
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Eric W Etchill
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Katherine A Giuliano
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Sandra R DiBrito
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Daniel Eisenson
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | | | | | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Armstrong Institute for Patient Safety and Quality, 1501Johns Hopkins Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alistair J Kent
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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16
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Boulton AJ, Peel D, Rahman U, Cole E. Evaluation of elderly specific pre-hospital trauma triage criteria: a systematic review. Scand J Trauma Resusc Emerg Med 2021; 29:127. [PMID: 34461976 PMCID: PMC8404299 DOI: 10.1186/s13049-021-00940-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pre-hospital identification of major trauma in elderly patients is key for delivery of optimal care, however triage of this group is challenging. Elderly-specific triage criteria may be valuable. This systematic review aimed to summarise the published pre-hospital elderly-specific trauma triage tools and evaluate their sensitivity and specificity and associated clinical outcomes. METHODS MEDLINE and EMBASE databases were searched using predetermined criteria (PROSPERO: CRD42019140879). Two authors independently assessed search results, performed data extraction, risk of bias and quality assessments following the Grading of Recommendations, Assessment, Development and Evaluation system. RESULTS 801 articles were screened and 11 studies met eligibility criteria, including 1,332,300 patients from exclusively USA populations. There were eight unique elderly-specific triage criteria reported. Most studies retrospectively applied criteria to trauma databases, with few reporting real-world application. The Ohio Geriatric Triage Criteria was reported in three studies. Age cut-off ranged from 55 to 70 years with ≥ 65 most frequently reported. All reported existing adult criteria with modified physiological parameters using higher thresholds for systolic blood pressure and Glasgow coma scale, although the values used varied. Three criteria added co-morbidity or anti-coagulant/anti-platelet use considerations. Modifications to anatomical or mechanism of injury factors were used by only one triage criteria. Criteria sensitivity ranged from 44 to 93%, with a median of 86.3%, whilst specificity was generally poor (median 54%). Scant real-world data showed an increase in patients meeting triage criteria, but minimal changes to patient transport destination and mortality. All studies were at risk of bias and assessed of "very low" or "low" quality. CONCLUSIONS There are several published elderly-specific pre-hospital trauma triage tools in clinical practice, all developed and employed in the USA. Consensus exists for higher thresholds for physiological parameters, however there was variability in age-cut offs, triage criteria content, and tool sensitivity and specificity. Although sensitivity was improved over corresponding 'adult' criteria, specificity remained poor. There is a paucity of published real-world data examining the effect on patient care and clinical outcomes of elderly-specific triage criteria. There is uncertainty over the optimal elderly triage tool and further study is required to better inform practice and improve patient outcomes.
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Affiliation(s)
- Adam J Boulton
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK.
- Warwick Medical School, University of Warwick, Coventry, UK.
| | - Donna Peel
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Usama Rahman
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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17
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Kelly-Schuette KA, Prentice A, Orr A, Levine A, Zarnke A, Pardington E, Pounders S, Lypka M, Krech L, Iskander G, Chapman AJ, Gibson CJ, Steensma E, Durling L. Rib Fracture Mortality: Are there clues in the core? J Surg Res 2021; 268:25-32. [PMID: 34280662 DOI: 10.1016/j.jss.2021.06.020] [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: 03/17/2021] [Revised: 05/11/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sarcopenia is associated with increased morbidity and mortality in the trauma patient. The primary objective of this study was to determine the relationship of psoas cross sectional area with hospital mortality in patients with rib fractures over the age of 55 years. MATERIALS AND METHODS We retrospectively reviewed 1223 patients presenting to a Level 1 Trauma Center between 1/1/2002 and 1/31/2019. Psoas cross sectional area was measured using a polygonal tracing tool. Patients were stratified into four quartiles based on sex-specific values. RESULTS There was increased in-hospital mortality for patients with a lower psoas cross sectional area (10 %, 8%, 6%, and 4%, Q1-Q4 respectively; P=0.021). The logistic regression model determined for every increase in psoas cross sectional area by 1 cm2 the odds of in-hospital mortality decreased by 4%. CONCLUSIONS In-hospital mortality is multifactorial; however, psoas cross sectional area may provide a clue in predicting adverse outcomes after traumatic rib fractures.
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Affiliation(s)
- Kathrine A Kelly-Schuette
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI.
| | - Anthony Prentice
- Spectrum Health Department of Nursing, Surgical Services, Grand Rapids, MI
| | - Adam Orr
- Spectrum Health/Michigan State University College of Human Medicine Diagnostic Radiology Residency, Grand Rapids, MI
| | - Anna Levine
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI
| | - Allison Zarnke
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI
| | - Emily Pardington
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI
| | - Steffen Pounders
- Spectrum Health Office of Research, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Matthew Lypka
- Spectrum Health Office of Research, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Laura Krech
- Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Gaby Iskander
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Office of Research, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Alistair J Chapman
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Charles J Gibson
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Elizabeth Steensma
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Luke Durling
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
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18
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Cuevas-Østrem M, Røise O, Wisborg T, Jeppesen E. Epidemiology of geriatric trauma patients in Norway: A nationwide analysis of Norwegian Trauma Registry data, 2015-2018. A retrospective cohort study. Injury 2021; 52:450-459. [PMID: 33243523 DOI: 10.1016/j.injury.2020.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Geriatric patients have a high risk of poor outcomes after trauma and is a rapid-increasing group within the trauma population. Given the need to ensure that the trauma system is targeted, efficient, accessible, safe and responsive to all age groups the aim of the present study was to explore the epidemiology and characteristics of the Norwegian geriatric trauma population and assess differences between age groups within a national trauma system. MATERIALS AND METHODS This retrospective analysis is based on data from the Norwegian Trauma Registry (2015-2018). Injury severity was scaled using the Abbreviated Injury Scale (AIS), and the New Injury Severity Score (NISS). Trauma patients 16 years or older with NISS ≥9 were included, dichotomized into age groups 16-64 years (Group 1, G1) and ≥65 years (Group 2, G2). The groups were compared with respect to differences in demographics, injury characteristics, management and outcome. Descriptive statistics and relevant parametric and non-parametric tests were used. RESULTS Geriatric patients proved to be at risk of sustaining severe injuries. Low-energy falls predominated in G2, and the AIS body regions 'Head' and 'Pelvis and lower extremities' were most frequently injured. Crude 30-day mortality was higher in G2 compared to G1 (G1: 2.9 vs. G2: 13.6%, P<0.01) and the trauma team activation (TTA) rate was lower (G1: 90 vs. G2: 73%, P<0.01). A lower proportion of geriatric patients were treated by a physician prehospitally (G1: 30 vs. G2: 18%, [NISS 15-24], P<0.01) and transported by air-ambulance (G1: 24 vs. G2: 14%, [NISS 15-24], P<0.01). Median time from alarm to hospital admission was longer for geriatric patients (G1: 71 vs. G2: 78 min [NISS 15-24], P<0.01), except for the most severely injured patients (NISS≥25). CONCLUSION In this nationwide study comparing adult and geriatric trauma patients, geriatric patients were found to have a higher mortality, receive less frequently advanced prehospital treatment and transportation, and a lower TTA rate. This is surprising in the setting of a Nordic country with free access to publicly funded emergency services, a nationally implemented trauma system with requirements to pre- and in-hospital services and a national trauma registry with high individual level coverage from all trauma-receiving hospitals. Further exploration and a deeper understanding of these differences is warranted.
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Affiliation(s)
- Mathias Cuevas-Østrem
- Faculty of Health Sciences, University of Stavanger, Norway; Department of Research, Norwegian Air Ambulance Foundation, NO-0103 Oslo, Norway.
| | - Olav Røise
- Faculty of Health Sciences, University of Stavanger, Norway; Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torben Wisborg
- Anesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway
| | - Elisabeth Jeppesen
- Faculty of Health Sciences, University of Stavanger, Norway; Department of Research, Norwegian Air Ambulance Foundation, NO-0103 Oslo, Norway
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Upadhyaya GK, Iyengar KP, Jain VK, Garg R. Evolving concepts and strategies in the management of polytrauma patients. J Clin Orthop Trauma 2021; 12:58-65. [PMID: 33716429 PMCID: PMC7920163 DOI: 10.1016/j.jcot.2020.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/04/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
Major trauma is one of the leading causes of morbidity and mortality in young adults. The impact of disability on the quality of life and functionality in this younger population is worrisome. This remains a major public health concern across the globe. Immediate and early deaths account for nearly 80% of trauma deaths occurring within the first few hours of injury to the first few days, usually because of traumatic brain injury or major exsanguination and subsequently due to shock or hypoxia. Worldwide adoption of comprehensive trauma systems and evolving models of trauma care including prehospital interventions have led improvements in trauma and critical care over the last few decades. Resuscitation and damage control orthopaedics are two key pillars in the management of polytrauma patient. Trauma-related coagulopathy can be an emerging complication during resuscitation of such patients which should be recognized early so appropriate corrective measures can be undertaken. We describe the evolving models of care in the management of polytrauma and trauma associated coagulopathy.
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Affiliation(s)
- Gaurav K. Upadhyaya
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, 229405, India
| | | | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
- Corresponding author. Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India.
| | - Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
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21
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GÜLER H, KAYA A, ŞENOL E, BELPINAR MS, AKTAŞ EÖ. 65 yaş ve üzeri olgular için düzenlenen adli raporların retrospektif incelenmesi. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.790460] [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] Open
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22
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Leede E, Fry L, Crosby L, Hamilton S, Ali S, Brown C. Impact of geriatric trauma service on the outcome of older trauma patents. Geriatr Gerontol Int 2020; 20:817-821. [DOI: 10.1111/ggi.13979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/25/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Emily Leede
- Department of Surgery and Perioperative Care, Medical Doctorate Candidate Dell Medical School at the University of Texas at Austin Austin Texas USA
| | - Liam Fry
- Department of Internal Medicine Dell Medical School at the University of Texas at Austin, Seton Healthcare Family Austin Texas USA
| | | | | | - Sadia Ali
- Seton Healthcare Family Austin Texas USA
| | - Carlos Brown
- Department of Surgery and Perioperative Care Dell Medical School at the University of Texas at Austin, Seton Healthcare Family Austin Texas USA
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French J, Agius LM, Sandiford NA. Managing the multiply injured patient: the impact of multidisciplinary teams. Br J Hosp Med (Lond) 2020; 80:703-706. [PMID: 31822166 DOI: 10.12968/hmed.2019.80.12.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of trauma has been tackled at a national level to improve patient care and mortality. Decision making through a multidisciplinary team approach has resulted in improved patient outcomes through a complex combination of changes. While the focus of trauma care delivery has been towards establishing an effective multidisciplinary trauma service, there are still improvements which can be made. This article reviews the history of trauma care in the UK, and the impact that multidisciplinary teams have had on the management of the multiply injured patient.
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Affiliation(s)
- Jonathan French
- Registrar, Joint Reconstruction Unit, Southland Teaching Hospital, Southern District Health Board, Invercargill, New Zealand
| | - Lewis M Agius
- Registrar, Joint Reconstruction Unit, Southland Teaching Hospital, Southern District Health Board, Invercargill, New Zealand
| | - Nemandra A Sandiford
- Consultant, Joint Reconstruction Unit, Southland Teaching Hospital, Southern District Health Board, Invercargill, New Zealand
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Cuevas-Østrem M, Røise O, Wisborg T, Jeppesen E. Geriatric Trauma - A Rising Tide. Assessing Patient Safety Challenges in a Vulnerable Population Using Norwegian Trauma Registry Data and Focus Group Interviews: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e15722. [PMID: 32352386 PMCID: PMC7226039 DOI: 10.2196/15722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Elderly trauma patients constitute a vulnerable group, with a substantial risk of morbidity and mortality even after low-energy falls. As the world's elderly population continues to increase, the number of elderly trauma patients is expected to increase. Limited data are available about the possible patient safety challenges that elderly trauma patients face. The outcomes and characteristics of the Norwegian geriatric trauma population are not described on a national level. OBJECTIVE The aim of this project is to investigate whether patient safety challenges exist for geriatric trauma patients in Norway. An important objective of the study is to identify risk areas that will facilitate further work to safeguard and promote quality and safety in the Norwegian trauma system. METHODS This is a population-based mixed methods project divided into 4 parts: 3 quantitative retrospective cohort studies and 1 qualitative interview study. The quantitative studies will compare adult (aged 16-64 years) and elderly (aged ≥65 years) trauma patients captured in the Norwegian Trauma Registry (NTR) with a date of injury from January 1, 2015, to December 31, 2018. Descriptive statistics and relevant statistical methods to compare groups will be applied. The qualitative study will comprise focus group interviews with doctors responsible for trauma care, and data will be analyzed using a thematic analysis to identify important themes. RESULTS The project received funding in January 2019 and was approved by the Oslo University Hospital data protection officer (No. 19/16593). Registry data have been extracted for 33,344 patients, and the analysis of these data has begun. Focus group interviews will be conducted from spring 2020. Results from this project are expected to be ready for publication from fall 2020. CONCLUSIONS By combining data from the NTR with interviews with doctors responsible for treatment and transfer of elderly trauma patients, we will provide increased knowledge about trauma in Norwegian geriatric patients on a national level that will form the basis for further research aiming at developing interventions that hopefully will make the trauma system better equipped to manage the rising tide of geriatric trauma. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/15722.
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Affiliation(s)
- Mathias Cuevas-Østrem
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Olav Røise
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torben Wisborg
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Elisabeth Jeppesen
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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