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Aarsland MA, Weber C, Enoksen CH, Dalen I, Tjosevik KE, Oord P, Thorsen K. Characteristics and demography of low energy fall injuries in patients > 60 years of age: a population-based analysis over a decade with focus on undertriage. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02465-3. [PMID: 38324199 DOI: 10.1007/s00068-024-02465-3] [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: 11/07/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND An increasing group of elderly patients is admitted after low energy falls. Several studies have shown that this patient group tends to be severely injured and is often undertriaged. METHODS Patients > 60 years with low energy fall (< 1 m) as mechanism of injury were identified from the Stavanger University Hospital trauma registry. The study period was between 01.01.11 and 31.12.20. Patient and injury variables as well as clinical outcome were described. Undertriage was defined as patients with a major trauma, i.e., Injury Severity Score (ISS) > 15, without trauma team activation. Statistical analysis was performed using the Chi-squared test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS Over the 10-year study period, 388 patients > 60 years with low energy fall as mechanism of injury were identified. Median age was 78 years (IQR 68-86), and 53% were males. The location of major injury was head injury in 41% of the patients, lower extremities in 19%, and thoracic injuries in 10%. Thirty-day mortality was 13%. Fifty percent were discharged to home, 31% to nursing home, 9% in hospital mortality, and the remaining 10% were transferred to other hospitals or rehabilitation facilities. Ninety patients had major trauma, and the undertriage was 48% (95% confidence interval, 38 to 58%). CONCLUSIONS Patients aged > 60 years with low energy falls are dominated by head injuries, and the 30-day mortality is 13%. Patients with major trauma are undertriaged in half the cases mandating increased awareness of this patient group.
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Affiliation(s)
- Martine A Aarsland
- Section for Traumatology; Surgical Clinic, Stavanger University Hospital, Stavanger, Norway.
- Department of Orthopaedic Surgery, Stavanger University Hospital, PO Box 8100, N-4068, Stavanger, Norway.
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Cathrine H Enoksen
- Section for Traumatology; Surgical Clinic, Stavanger University Hospital, Stavanger, Norway
- Department of Orthopaedic Surgery, Stavanger University Hospital, PO Box 8100, N-4068, Stavanger, Norway
| | - Ingvild Dalen
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Kjell Egil Tjosevik
- Section for Traumatology; Surgical Clinic, Stavanger University Hospital, Stavanger, Norway
- Department of Emergency Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Pieter Oord
- Section for Traumatology; Surgical Clinic, Stavanger University Hospital, Stavanger, Norway
- Department of Orthopaedic Surgery, Stavanger University Hospital, PO Box 8100, N-4068, Stavanger, Norway
| | - Kenneth Thorsen
- Section for Traumatology; Surgical Clinic, Stavanger University Hospital, Stavanger, Norway
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Anand T, Crawford AE, Sjoquist M, Hashmi ZG, Richter RP, Joseph B, Richter JR. Decreased Glycocalyx Shedding on Presentation in Hemorrhaging Geriatric Trauma Patients. J Surg Res 2024; 293:709-716. [PMID: 37844411 PMCID: PMC11075129 DOI: 10.1016/j.jss.2023.09.047] [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: 03/02/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Plasma levels of syndecan-1 (Sdc-1), a biomarker of endothelial glycocalyx (EG) damage, correlate with worse outcomes in trauma patients. However, EG injury is not well characterized in injured older adults (OA). The aims of this study were to characterize Sdc-1 shedding in OA trauma patients relative to younger adults (YA) and determine associations with putative regulators of EG sheddases. METHODS We performed a secondary analysis of data from the Pragmatic, Randomized Optimal Platelet, and Plasma Ratios (PROPPR) trial, stratifying bluntly injured subjects into OA and YA groups based on upper age quartile (57 y). Plasma Sdc-1 levels were compared in OA and YA at hospital arrival through postinjury day 3, and the independent association between age and Sdc-1 level at arrival was determined after adjusting for differences in gender, shock index (SI), and pre-existing comorbidities. In a follow-up analysis, case-control matching was used to create populations of OA and YA with equivalent SI and injury severity score. Levels of Sdc-1 were compared between these matched groups, and the relationships with candidate regulators of EG shedding were assessed. RESULTS Of 680 subjects in the Pragmatic, Randomized Optimal Platelet, and Plasma Ratios trial, 350 (51%) had blunt injuries, and 92 (26.3%) of these were OA. Plasma Sdc-1 levels at arrival, 2 h, and 6 h were significantly lower in OA compared to YA (all P < 0.05). After adjusting for sex, pre-existing morbidities and SI, age was associated with decreased Sdc-1 levels at arrival. In the matched analyses, Sdc-1, high-mobility group box 1 and tissue inhibitor of metalloproteinase-2 levels were lower in OA compared to YA. Both high-mobility group box-1 and tissue inhibitor of metalloproteinase-2 significantly correlated with arrival Sdc-1 and were inversely associated with age. CONCLUSIONS This study indicates that increased age is independently associated with decreased Sdc-1 levels among patients with blunt injuries. Suppressed plasma levels of sheddases in relation to diminished Sdc-1 shedding suggest that mechanisms regulating EG cleavage may be impaired in injured older adults. These findings provide novel insight into the age-dependent impact of injury on the vascular endothelium, which could have important implications for the clinical management of older adults following trauma.
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Affiliation(s)
- Tanya Anand
- Division of Trauma, Critical Care, Burn & Emergency Surgery, Department of Surgery, University of Arizona, Tucson, Arizona. https://twitter.com/tanyaanand8
| | - Anna E Crawford
- University of Alabama at Birmingham Heersink College of Medicine, Birmingham, Alabama
| | | | - Zain G Hashmi
- Division of Trauma & Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert P Richter
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burn & Emergency Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Jillian R Richter
- Division of Trauma & Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama.
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Esper GW, Meltzer-Bruhn AT, Herbosa CG, Ganta A, Egol KA, Konda SR. Defining Characteristics of Middle-Aged and Geriatric Orthopedic Trauma in New York City over a 7-Year Period. Arch Gerontol Geriatr 2023; 112:105039. [PMID: 37088016 DOI: 10.1016/j.archger.2023.105039] [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: 01/24/2023] [Revised: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES Examine the patterns and defining characteristics of middle-aged and geriatric patients who sustain orthopedic trauma in New York City. STUDY DESIGN Retrospective cohort study. METHODS 11,677 patients >55 years old treated for traumatic orthopedic injuries were grouped into cohorts based on their age group (cohorts of 55-64, 65-74, 75-84, 85-94, ≥95 years) and year of presentation (2014-2021). Each patient was reviewed for demographics/comorbidities, injury mechanism/type, mortality data. Comparative analyses were conducted. RESULTS The average age of our cohort was 74 years old. The majority of patients were female (69%) and sustained their injuries via a ground level fall. The most common injuries sustained by patients occurred at the upper extremity (40%), hip (26%), and lower extremity (25%) with 820 (7%) patients sustaining polytrauma. The incidence of hip fractures and pelvic injuries increased with older age. Older patients had a higher rate of mortality through 1-year in addition to a longer length of stay. In contrast, the incidence of injury to the upper and lower extremity decreased with older age. CONCLUSIONS The rate of mortality out through 1-year following orthopedic trauma increased as patients got older. Significantly more women experienced a traumatic injury during 2014-2021. As age increased, ground level falls were the most common mechanism of injury with injuries more likely to occur in the axial skeleton, notably the hip and pelvis. Younger patients experienced higher rates of upper and lower extremity trauma. Providers should keep these patterns in mind to optimize care for middle-aged and geriatric trauma patients.
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Affiliation(s)
- Garrett W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, United States
| | - Ariana T Meltzer-Bruhn
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, United States
| | - Christopher G Herbosa
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, United States
| | - Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, United States; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY, United States
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, United States; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY, United States
| | - Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, United States; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY, United States.
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Myklevoll KR, Zakariassen E, Morken T, Baste V, Blinkenberg J, Bondevik GT. Primary care doctors in acute call-outs to severe trauma incidents in Norway - associations with factors related to patients and doctors. Scand J Prim Health Care 2023; 41:196-203. [PMID: 37256689 PMCID: PMC10478583 DOI: 10.1080/02813432.2023.2216235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE Severe trauma patients need immediate prehospital intervention and transfer to a specialised trauma hospital. In Norway, primary care doctors (PCDs) are an integrated part of the prehospital trauma care. The aim of this study was to investigate the degree to which PCDs were involved in prehospital care of severe trauma patients and how factors related to patients and doctors were associated with call-outs to these incidents. DESIGN This was a registry-based study in Norway on severe trauma patients with acute hospital admission during the period 2012-2018. SETTING Data was obtained from three Norwegian official registries. SUBJECTS By linking the registries, we studied the actions taken by the PCDs, whether they called out to severe trauma incidents. MAIN OUTCOME MEASURES In multivariable regression models, we investigated whether factors related to the PCDs (age, sex, specialisation in general practice (GP)) and patients (age, sex, duration of hospital stay, type of injury) were associated with call-outs. RESULTS Out of 4342 severe trauma incidents, PCDs had documented involvement in 1683 (39%) and called out to 644 (15%). Increased proportions of PCD call-outs to severe trauma incidents were significantly associated with lower age of PCD, being a GP specialist, lower patient age, being a male patient, increased length of hospital stay and injuries to the head and the neck. CONCLUSIONS PCDs called out to a relatively low proportion of severe trauma patients. Several factors related to patients and doctors were associated with call-outs to severe trauma incidents in Norway.
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Affiliation(s)
- Kristian Rikstad Myklevoll
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Erik Zakariassen
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Tone Morken
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jesper Blinkenberg
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Gunnar Tschudi Bondevik
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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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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Koch DA, Hagebusch P, Lefering R, Faul P, Hoffmann R, Schweigkofler U. Changes in injury patterns, injury severity and hospital mortality in motorized vehicle accidents: a retrospective, cross-sectional, multicenter study with 19,225 cases derived from the TraumaRegister DGU ®. Eur J Trauma Emerg Surg 2023; 49:1917-1925. [PMID: 36890307 PMCID: PMC9994772 DOI: 10.1007/s00068-023-02257-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE In the last 20 years, the number of fatalities due to road traffic accidents (RTA) in Germany has steadily decreased from 7503 to 2724 per year. Due to legal regulations, educational measures and the continuous development of safety technology the number of severe traumatic injuries and injury patterns are most likely to change. The aim of the study was to analyse severely injured motorcyclists (MC) and car occupants (CO) that were involved in RTAs in the last 15 years and investigate the development and changes of injury patterns, injury severity and hospital mortality. METHODS We retrospectively evaluated data from the TraumaRegister DGU® (TR-DGU) considering all RTA-related injured MCs and COs (n = 19,225) that were registered in the TR-DGU from 2006 to 2020 with a primary admission to a trauma center with continuous participation (14 of 15 years) in the TR-DGU, an Injury Severity Score (ISS) ≥ 16 and aged between 16 and 79 years. The observation period was divided into three 5-year interval subgroups for further analysis. RESULTS The mean age increased by 6.9 years and the ratio of severely injured MCs to COs changed from 1:1.92 to 1:1.45. COs were in 65.8% male and more often severely injured in the age groups under 30, while the majority of severely injured MCs were in the age group around 50 years and in 90.1% male. The ISS (- 3.1 points) as well as the mortality of both groups (CO: 14.4% vs. 11.8%; MC: 13.2% vs. 10.2%) steadily decreased over time. Nevertheless, the standardized mortality ratio (SMR) hardly changed and stayed < 1. Regarding the injury patterns, the greatest decline of injuries with AIS 3 + were to the head (CO: - 11.3%; MC: - 7.1%), in addition, a decrease of injuries to extremities (CO: - 1.5%; MC: - 3.3%), to the abdomen (CO: - 2.6%; MC: - 3.6%), to the pelvis in COs (- 4.7%) and to the spine (CO: + 0.1%; MC: - 2.4%) were observed. Thoracic injuries increased in both groups (CO: + 1.6%; MC: + 3.2%) and, furthermore, pelvic injuries in MCs (+ 1.7%). Another finding was the increase of the utilization of whole body CTs from 76.6 to 95.15%. CONCLUSION The severity of injuries and their incidence, especially head injuries, have decreased over the years and seem to contribute to a decreasing hospital mortality of polytraumatized MCs and COs injured in traffic accidents. Young drivers and an increasing number of seniors are the age groups at risk and require special attention and treatment.
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Affiliation(s)
- Daniel Anthony Koch
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Paul Hagebusch
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Ostmerheimer Straße 200, 51109 Cologne, Germany
| | - Philipp Faul
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - TraumaRegister DGU
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Ostmerheimer Straße 200, 51109 Cologne, Germany
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Larsson G, Axelsson C, Hagiwara MA, Herlitz J, Magnusson C. Characteristics of a trauma population in an ambulance organisation in Sweden: results from an observational study. Scand J Trauma Resusc Emerg Med 2023; 31:33. [PMID: 37365663 DOI: 10.1186/s13049-023-01090-0] [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: 02/05/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Globally, injuries are a major health problem, and in Sweden, injuries are the second most common reason for ambulance dispatch. However, there is a knowledge gap regarding the epidemiology of injuries requiring assessment by emergency medical services (EMS) in Sweden. The aim of the present study was to describe the prehospital population with injuries that have been assessed and treated by EMS. METHODS A randomly selected retrospective sample was collected from 1 January through 31 December 2019 in a region in southwestern Sweden. Data were collected from ambulance and hospital medical records. RESULTS Among 153,724 primary assignments, 26,697 (17.4%) were caused by injuries. The study cohort consisted of 5,235 patients, of whom 50.5% were men, and the median age was 63 years. The most common cause of injury was low-energy fall (51.4%), and this was the cause in 77.8% of those aged > 63 years and in 26.7% of those aged ≤ 63 years. The injury mechanism was a motor vehicle in 8.0%, a motorcycle in 2.1% and a bicycle in 4.0%. The most common trauma location was the residential area (55.5% overall; 77.9% in the elderly and 34.0% in the younger group). In the prehospital setting, the most frequent clinical sign was a wound (33.2%), a closed fracture were seen in 18.9% and an open fracture in 1.0%. Pain was reported in 74.9% and 42.9% reported severe pain. Medication was given to 42.4% of patients before arrival in the hospital. The most frequent triage colour according to the RETTS was orange (46.7%), whereas only 4.4% were triaged red. Among all patients, 83.6% were transported to the hospital, and 27.8% received fracture treatment after hospital admission. The overall 30-day mortality rate was 3.4%. CONCLUSION Among EMS assignments in southwestern Sweden, 17% were caused by injury equally distributed between women and men. More than half of these cases were caused by low-energy falls, and the most common trauma location was a residential area. The majority of the victims had pain upon arrival of the EMS, and a large proportion appeared to have severe pain.
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Affiliation(s)
- Glenn Larsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden.
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Christer Axelsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
| | - Johan Herlitz
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
| | - Carl Magnusson
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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de Godoi Rezende Costa Molino C, Rübel L, Mantegazza N, Bischoff-Ferrari HA, Freystaetter G. Association of polypharmacy with cognitive impairment in older trauma patients: a cross-sectional study. Eur J Hosp Pharm 2023:ejhpharm-2022-003645. [PMID: 36882299 DOI: 10.1136/ejhpharm-2022-003645] [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: 12/05/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Few if any studies have been conducted to date on the association between polypharmacy and cognitive impairment among older trauma patients. Therefore, we investigated whether polypharmacy is associated with cognitive impairment in trauma patients aged ≥70 years. METHODS This is a cross-sectional study of patients aged ≥70 years hospitalised due to a trauma-related injury. Cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score ≤24 points. Medications were coded according to the Anatomical Therapeutic Chemical classification. Three exposures were examined: polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and number of medications. Separate logistic regression models adjusted for age, sex, body mass index (BMI), education, smoking, independent living, frailty, multimorbidity, depression, and type of trauma were used to test the association between the three exposures and cognitive impairment. RESULTS A total of 198 patients were included (mean age 80.2; 64.7% women and 35.4% men), of which 148 (74.8%) had polypharmacy and 63 (31.8%) had excessive polypharmacy. The prevalence of cognitive impairment was 34.3% overall, 37.2% in the polypharmacy group and 50.8% in the excessive polypharmacy group. More than 80% of participants were taking at least one analgesic. Overall, polypharmacy was not statistically significantly associated with cognitive impairment (odds ratio (OR) 1.20 [95% confidence interval (CI) 0.46 to 3.11]). However, patients in the excessive polypharmacy group were more than two times more likely to have cognitive impairment (OR 2.88 [95% CI 1.31 to 6.37]) even after adjustments for relevant confounders. Similarly, the number of medications was associated with greater odds of cognitive impairment (OR 1.15 [95% CI 1.04 to 1.28]) after adjustments for the same relevant confounders. CONCLUSION Cognitive impairment is common among older trauma patients, particularly among those in the excessive polypharmacy group. Polypharmacy was not associated with cognitive impairment. Excessive polypharmacy and number of medications, on the other hand, were associated with greater odds of cognitive impairment in older trauma patients.
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Affiliation(s)
- Caroline de Godoi Rezende Costa Molino
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lisa Rübel
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
| | - Noemi Mantegazza
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- University Clinic for Aging Medicine, City Hospital, Zurich, Waid, Zurich, Switzerland
| | - Gregor Freystaetter
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- University Clinic for Aging Medicine, City Hospital, Zurich, Waid, Zurich, Switzerland
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9
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Comorbidities, injury severity and complications predict mortality in thoracic trauma. Eur J Trauma Emerg Surg 2022; 49:1131-1143. [PMID: 36527498 PMCID: PMC10175434 DOI: 10.1007/s00068-022-02177-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/12/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Purpose
Thoracic trauma accounts for 25–50% of posttraumatic mortality. Data on epidemiology of thoracic trauma in Scandinavia and risk factors for mortality are scarce. This study aims to provide an overview of epidemiology, clinical events and risk factors for mortality of patients with severe thoracic injuries.
Methods
A retrospective study including adult thoracic trauma patients with abbreviated injury scale ≥ 3, between 2009 and 2018 at Haukeland University Hospital was performed. Subgroup analyses were performed for specific patient groups: (1) isolated thoracic trauma, (2) polytrauma without Traumatic Brain Injury (TBI) and (3) polytrauma with TBI. Logistic regression analyses were applied to find risk factors for 30-days mortality. Age, sex, comorbidity polypharmacy score (CPS), trauma and injury severity score (TRISS) and comprehensive complication index (CI) were included in the final model.
Results
Data of 514 patients were analyzed, of which 60 (12%) patients died. Median (IQR) injury severity score (ISS) was 17 (13–27). Data of 463 patients, of which 39 patients died (8%), were included in multivariate analyses. Female sex odds ratio (OR) (2.7, p = 0.04), CPS > 9 (OR 4.8; p = 0.01), TRISS ≤ 50% (OR 44; p < 0.001) and CI ≥ 30 (OR 12.5, p < 0.001) were significant risk factors for mortality. Subgroup analyses did not demonstrate other risk factors.
Conclusion
Comorbidities and associated pharmacotherapies, TRISS, female sex, and complications during admission predict in-hospital mortality after thoracic trauma. Current findings might help to recognize patients at risk of an adverse outcome, and thereby prevent complications.
Trial registration: retrospectively registered
The regional committees for medical and health research ethics file number is 2017/293.
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Trier F, Fjølner J, Sørensen AH, Søndergaard R, Kirkegaard H, Raaber N. Ten‐year trends of adult trauma patients in Central Denmark Region from 2010 to 2019: A retrospective cohort study. Acta Anaesthesiol Scand 2022; 66:1130-1137. [PMID: 36106860 PMCID: PMC9541060 DOI: 10.1111/aas.14123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
Background Trauma causes significant economic and societal burdens, and the trauma patient population and their prognosis change over time. This study aims to analyze 10‐year trends of trauma patients at a major trauma center in Central Denmark Region. Methods Five thousand three hundred and sixty‐six patients aged ≥16 years with Injury Severity Score (ISS) > 0 admitted by trauma team activation at a major trauma center between January 1, 2010, and December 31, 2019, were included. An annual percent change with a 95% confidence interval was used to estimate trends in the mechanism of injuries. Multiple logistic regression with mortality as the outcome was adjusted for age, sex, and ISS. Admission year was used as continuous variable in logistic regressions. Results The median age increased from 37 in 2010 to 49 in 2019, and the proportion of patients aged ≥65 doubled. The annual incidence of minor injuries (ISS 1–15) decreased from 181.3/105 inhabitants in 2010 to 112.7/105 in 2019. Severe injuries (ISS > 15) increased from 10.1/105 inhabitants in 2010 to 13.6/105 in 2019. The proportion of patients with ISS > 15 increased from 18.1% in 2010 to 31.1% in 2019. Multivariable logistic regression indicates lower 30‐day mortality for all trauma patients over the study period when adjusting for age, sex, and ISS (odds ratio: 0.94, 95% CI: 0.90–0.99). The 30‐day mortality for severely injured patients with ISS > 15 seems to decrease during the study period when adjusting for age, sex, and ISS (Odds ratio: 0.92, 95% CI: 0.87–0.97). Fall injuries increased by 4.1% annually (95% CI: 2.3%–6.1%). Conclusions Ten‐year trends of trauma patients at a major trauma center show an increasing median age, injury severity, and number of fall injuries. The 30‐day mortality of trauma patients decreased slightly for both minor injuries and severe injuries when adjusting for age, sex, and injury severity.
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Affiliation(s)
- Frederik Trier
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department Aarhus University and Aarhus University Hospital Aarhus Denmark
| | - Jesper Fjølner
- Department of Anesthesia and Intensive Care Viborg Regional Hospital Viborg Denmark
- Research and Development Prehospital Emergency Medical Services, Central Denmark Region Aarhus Denmark
| | - Anders Høyer Sørensen
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department Aarhus University and Aarhus University Hospital Aarhus Denmark
| | - Rasmus Søndergaard
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department Aarhus University and Aarhus University Hospital Aarhus Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department Aarhus University and Aarhus University Hospital Aarhus Denmark
| | - Nikolaj Raaber
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department Aarhus University and Aarhus University Hospital Aarhus Denmark
- Research and Development Prehospital Emergency Medical Services, Central Denmark Region Aarhus Denmark
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