Trauma in elderly patients: a study of prevalence, comorbidities and gender differences

Assessment of Volume and Fluid Resuscitation Strategies for Critically Ill Geriatric Trauma Patients: A Systematic Review

OBJECTIVE

This study aims to evaluate fluid resuscitation strategies including volume assessment measures, conservative versus aggressive fluid resuscitation, and multifocal fluid resuscitation protocols in critically ill geriatric trauma patients.

DATA SOURCES

A comprehensive search was conducted across five databases including PubMed, Google Scholar, ProQuest, Embase, and Cochrane.

STUDY SELECTION

Studies were included based on their relevance to volume assessment measures, conservative versus aggressive fluid resuscitation, and multifocal fluid resuscitation protocols in critically ill geriatric trauma patients.

DATA EXTRACTION

A total of 14 studies met the inclusion criteria. Outcomes of interest included mortality, intensive care unit length of stay, ventilator days, and in-hospital complications.

DATA SYNTHESIS

The initial query identified 1,257 studies, and after inclusion/exclusion criteria, a total of 14 studies were evaluated. On average, serum lactate levels above 2.5 mmol/L were found to be significantly associated with mortality. Conservative approaches to fluid resuscitation that were on average <1,500 cc were also found to decrease mortality and incur no increase in in-hospital complications. Additionally, goal-oriented geriatric fluid resuscitation protocols utilizing multiple measures for hemodynamic stability were found to reduce mortality in patients following the implementation of the protocol.

CONCLUSION

Serum lactate level kept on average below 2.5 mmol/L has shown to be an effective volume assessment measure and associated with decreased mortality. Additionally, conservative fluid resuscitation with volume maintained on average <15,000 cc was also associated with decreased mortality compared to aggressive fluid resuscitation measures. Lastly, goal-oriented geriatric fluid resuscitation protocols that aimed to maintain multiple volume assessment measures were associated with decreased mortality and complication rates. Implementation of these protocols has the potential to significantly improve outcomes in this vulnerable population.

Surgical outcome following primary closure of auricular lacerations

PURPOSE

To evaluate the aesthetic outcomes of primary closure of auricle lacerations in the emergency department.

METHODS

In this prospective case study in our tertiary referral center we included all patients with an auricular laceration without complete avulsion. Wound treatment involved thorough cleaning and primary closure. Photos of the auricle were taken at various stages for evaluation. To evaluate the achieved results after 3 months, a success classification system with four classes was developed: (1) full success, no irregularities, (2) partial success, only minor irregularities, (3a) unsuccessful, major irregularities or (3b) unsuccessful, (partial) necrosis.

RESULTS

Most patients demonstrated successful outcomes (60.7% full success and 32.1% partial success), with helical involvement being associated with inferior results. The interobserver percent agreement of the classification system was 88%. The Fleiss' kappa coefficient was 0.570, p < 0.001.

CONCLUSION

Primary closure of ear lacerations results in a high success rate. We have introduced a revised classification system to qualify the success of treatment of the auricle laceration. Involvement of the helix is correlated with inferior surgical results three months after surgical closure. Trial registration number and date of registration: reference number W21_387 # 21.432, September 9, 2021.

Major trauma and comorbidity: a scoping review

PURPOSE

Major trauma is a leading cause of acute morbidity and mortality. While injury severity drives much of the associated burden, pre-existing comorbidities may influence both acute management and long-term outcomes. This scoping review examines the impact of comorbidities on trauma outcomes.

METHODS

Embase, Medline, CINAHL, Cochrane Library, and PubMed were systematically searched from inception to 22/04/2021 (update 22/03/2024). Studies investigating comorbidities as risk factors for adverse outcomes in adults (≥ 18 years) with major trauma were included.

RESULTS

Of 5448 studies identified, 33 met inclusion criteria. No studies examined whether comorbidities increases the risk of major trauma, and only two studies investigated the development of comorbidities post-trauma. Among trauma patients with pre-existing comorbidities particularly cardiovascular disease, diabetes, liver disease, and kidney disease were associated with higher case fatality. Comorbidities were also associated with increased morbidity, longer hospital stays and higher complication rates.

CONCLUSIONS

Trauma patients with comorbidities suffer experience worse outcomes, yet limited research explores whether comorbidities contribute to trauma risk or emerge as a consequence. Further research is needed to clarify these relationships and guide targeted interventions.

Injury patterns and patient outcomes of abdominal trauma in the elderly population: a 5-year experience of a Major Trauma Centre

INTRODUCTION

The management of abdominal trauma in older patients is challenging due to preexisting comorbidities, impaired physiology, frailty and atypical clinical presentations. Few studies focus on the characteristics of abdominal trauma in older populations.

METHODS

A retrospective service evaluation was conducted during the period January 2017 - December 2022 at University Hospital Southampton, the designated Major Trauma Centre (MTC) of Wessex Trauma Network in the United Kingdom. Data was collected from the local Trauma Registry. Patients aged ≥ 65 years old and with Abbreviated Injury Scale (AIS) over one for the Abdomen were included. Patients aged less than 65 years old and those who died on arrival to the MTC were excluded.

RESULTS

Out of 4977 geriatric trauma patients, only 150 cases (3%) were eligible, with a mean age of 77 years and a median Injury Severity Score of 22. The trauma team activation code was triggered in just under half of all cases (49%). All-level falls were the leading mechanism (52%) and low-energy falls were significantly higher in patients aged ≥ 85 years (P <0.001). The spleen was the most frequently affected organ (27%). About 47% of abdominal injuries were severe (AIS Abdomen ≥3) and about 22% of patients required surgical or radiological intervention. Three patients sustained occult abdominal injuries and one of them had a negative CT scan initially. The overall 30-day mortality rate was 20%. Of all casualties, most were polytrauma cases (87%).

CONCLUSION

Despite the low incidence of abdominal injuries in the elderly, when these occurred, almost half were serious with AIS Abdomen ≥ 3 and almost one in four required surgical or radiological intervention. The use of single-time imaging may not be sufficient to ensure the absence of injury, as delayed manifestations of occult abdominopelvic trauma may occur. Close monitoring and regular reassessments are recommended, even with a negative CT scan on arrival. The high all-cause mortality rate may correlate with the high incidence of polytrauma in this cohort and the failure to trigger a trauma call in the Emergency Department. Future studies should focus on the development of triage tools and include the use of validated and designated frailty tools for larger population analysis.

Incidence of Traumatic Spinal Injury Following Public Policy Update on Moped Usage in South Carolina

BACKGROUND

Electric scooters and mopeds have become prevalent modes of transportation for many Americans. On 19 November 2018, South Carolina implemented a law mandating the registration of these vehicles with the South Carolina Department of Motor Vehicles, enabling better regulation of moped and scooter drivers on the roads. This study aims to investigate whether the incidence of vertebral fractures and spinal cord injuries related to moped and scooter accidents decreased after the passage of this 2018 South Carolina law.

METHODS

Retrospective data from a cohort of 350 patients, 239 before ("prelaw") and 111 after the law ("postlaw") was implemented, seeking care at a level 1 trauma center for moped or scooter-related spinal injuries between January 2014 and December 2022 were analyzed. Differences in the incidence of vertebral fractures and spinal cord injuries before and after the passage of the South Carolina law were calculated. Vertebral fractures were categorized by location on the spine pre- and postlaw. χ 2, Wilcoxon rank sum, and Shapiro-Wilk tests were employed to compare variables between groups.

RESULTS

A total of 60 traumatic vertebral fractures (47 prelaw and 13 postlaw) and 7 spinal cord injuries involved moped accidents. There was no significant difference in the incidence rate of vertebral fractures (19.7% vs 11.7%, P = 0.09) or spinal cord injuries (2.9% vs 0%, P = 0.1) between those injured prelaw and postlaw, although there were significant differences between the groups in age (43.2 vs 47.4, P < 0.01) and incidence of men injured (87.9% vs 95.5%, P = 0.03). Multivariable logistic regression demonstrated suffering a moped-related traumatic injury before the implementation of the 2018 South Carolina law (OR = 2.08, 95% CI: 1.09-4.23, P = 0.03) and an increase in age at the time of injury (OR = 1.03, 95% CI: 1.01-1.05, P = 0.01) were independently associated with an increase in the odds ratio of suffering traumatic vertebral fractures following a moped accident when controlling for multiple confounding factors.

CONCLUSION

Before the implementation of a 2018 South Carolina law that increased moped regulations, moped drivers had a significantly higher odds ratio for suffering a traumatic vertebral fracture compared with after the implementation of the law when controlling for confounding factors. These findings suggest that public policy surrounding moped use may contribute to a decrease in the overall odds of suffering vertebral fractures resulting from moped use and emphasize the need for continual updates to public policy with public safety in mind. This is not only important from a standpoint of patient safety, but it also helps to decrease the amount of health care resources and dollars used.

CLINICAL RELEVANCE

Implementation of public policy surrounding use of mopeds may decrease overall odds of vertebral fractures, which may decrease subsequent health care resource utilization.

LEVEL OF EVIDENCE: 3

Predictors of prolonged hospitalization among geriatric trauma patients using the modified 5-Item Frailty index in a Middle Eastern trauma center: an 11-year retrospective study

BACKGROUND

Using a validated tool, we explored the prevalence, risk factors, and predictors of longer hospitalization among hospitalized geriatric patients.

METHODS

Retrospective and comparative analyses of age groups (55-64 vs. ≥ 65 years), gender, survival status, and frailty index categories were performed. The Modified 5-Item Frailty Index was assessed, and multivariable logistic regression analysis was performed to predict prolonged hospitalization (> 7 days).

RESULTS

There were 17,600 trauma hospitalizations with a mean age of 32 ± 15 years between 2010 and 2021; of them, 9.2% were geriatrics at ≥ 55-64 years (n = 935) and ≥ 65 years (n = 691). The female/male ratio was 17.5%/82.5%, and the mean injury severity score was 13 ± 9. The injury rate for age ≥ 65 was 24 per 10,000 compared to 10 per 10,000 in the younger group age (≥ 55-64). 35% of injuries occurred at home due to falls. Overall mortality was 8%, with a higher rate among males than females (9% vs. 4%). The deceased were three years older at the time of death compared to the survivors. Higher frailty grades were associated with home-related falls and head injuries. Patients 65 years or older were likely to have higher frailty scores, as indicated by higher percentages in the mFI-5. Among the older group, 25% were moderately frail, and 18% severely frail. In the younger group, 50% were frail. Higher frailty scores correlated with increased acute kidney injury, pneumonia, urinary tract infections, and longer hospital stays. Severe frailty significantly predicted longer hospitalization (odds ratio 1.83, p = 0.007).

CONCLUSION

One out of eleven trauma admissions was aged > 55. Head injury and bleeding were the leading causes of mortality in the study cohort. There was a significant decrease in the trend of geriatric trauma over the years. The modified FI-5 performs well as a predictive tool of prolonged hospitalizaion in trauma patients with different age groups.

Clinical Outcomes Following Component Therapy Only Versus Whole Blood Plus Component Versus Whole Blood Only in Geriatric Trauma Patients With Isolated Chest or Abdominal Injuries With or Without Traumatic Brain Injury

INTRODUCTION

This study aims to evaluate clinical outcomes in geriatric trauma patients with isolated chest or abdominal injuries with or without traumatic brain injury (TBI) receiving whole blood (WB), component (COMP), or WB and component therapy (WB + COMP).

METHODS

This retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program Participant Use File dataset from 2017 to 2021 evaluated geriatric (age ≥65) trauma patients with moderate-to-severe isolated chest (abbreviated injury scale (AIS) chest ≥2) or abdominal (AIS abdomen ≥2) injuries with or without TBI (AIS head ≥2) receiving WB, COMP, or WB + COMP. Outcomes included emergency department and 24-h mortality, blood product volume (mL) at 4 hs, and intensive care unit-length of stay.

RESULTS

Among non-TBI patients with isolated chest injuries, COMP patients required significantly less plasma (regression coefficient β = -428 mL, 95% confidence interval (CI): 604 mL-249 mL, P < 0.001), and had 48% lower odds of 24-h mortality than WB patients (odds ratio = 0.519, 95% CI: 0.285-0.946, P = 0.032). Among TBI patients with isolated chest injuries, there was no significant association between receiving COMP and plasma volume requirement (β = -166.227, 95% CI: -366.370 to 33.916, P = 0.104) or 24-h mortality (odds ratio = 0.606, 95% CI: 0.301-1.220, P = 0.161) when compared to WB patients.

CONCLUSIONS

Compared to WB or WB + COMP, COMP therapy significantly reduced transfusion requirements in non-TBI patients. Additionally, COMP therapy was associated with lower 24-h mortality in geriatric patients with isolated chest injuries. TBI patients with isolated chest injuries had no significant differences in clinical outcomes. Further research is warranted to explore the potential benefits of COMP therapy on mortality outcomes in TBI patients.

Preoperative goal directed therapy in geriatric hip fracture patients - a retrospective quality improvement study

BACKGROUND

Hip fractures in older adults are common and carry a high risk of morbidity and mortality. Preoperative dehydration, a key risk factor for adverse outcomes, is often underdiagnosed at admission. It is important to identify high risk patients and optimize modifiable risk factors to improve the postoperative outcome. The p-POSSUM Score is a useful predictor of postoperative mortality risk. Implementing a defined fluid resuscitation protocol early in high-risk groups has proven effective in reducing both postoperative morbidity and mortality.

MATERIALS AND METHODS

We conducted a single-center, retrospective quality improvement study at a Level 1 trauma center in Switzerland, focusing on geriatric patients over 70 with a p-POSSUM Score > 5% and a proximal femur fracture, undergoing surgery between February 2015 and September 2019. We hypothesized that our institutional goal-directed fluid resuscitation protocol (GDT) would result in lower 30- and 90-day mortality rates and fewer complications for these high-risk patients. Outcome changes over time were analyzed annually.

RESULTS

312 patients were included in our study. 147 followed our institutional GDT protocol, while 165 patients received standard care and were used as a control group. Initially, the odds ratio (OR) for 30-days mortality favored the GDT group; 2015 0.30 (CI: 0.07-1.18), 2016 0.28 (CI: 0.07-1.07), 2017 0.51 (CI: 0.13-2.04). This shifted toward the Non-GDT group in the year 2018 with a OR of 2.14 (CI: 0.59-7.84) and 2019 with 1.92 (CI 0.47-7.83). The pattern for 90-day mortality results was similar and slightly more pronounced. The estimates for the odds ratios remained consistent even after adjustment for the p-POSSUM score. The relative frequencies of complications showed no remarkable differences between the groups (GDT vs. Non-GDT).

CONCLUSION

In our study, the treatment according to our GDT protocol was associated with survival advantage in the first three years. However, this trend reversed in 2018, with Non-GDT patients faring better. Although our retrospective study does not provide enough evidence of causality between the protocol and the mortality rates, it revealed that continuous critical evaluation of internal processes is essential in healthcare for quality management. This allows timely identification and adaptation of processes to issues, especially after initially positive results.

Enhancing the Understanding of Abdominal Trauma During the COVID-19 Pandemic Through Co-Occurrence Analysis and Machine Learning

BACKGROUND

This study examines the impact of the COVID-19 pandemic on abdominal trauma management by comparing pre-pandemic (17 February 2018-26 February 2020) and pandemic periods (27 February 2020-7 March 2022).

METHODS

Analyzing data from 118 patients at the Emergency County Clinical Hospital of Craiova, we identified significant shifts in clinical practices affecting patient outcomes.

RESULTS

During the pandemic, a moderate increase in surgical interventions for specific abdominal traumas indicated the effective adaptation of the medical system. Prioritizing critical cases and deferring non-urgent procedures optimized limited resources. Demographic and clinical factors-including age, sex, body mass index (BMI), and red cell distribution width (RDW)-significantly influenced the hospitalization duration and recovery outcomes. Gender disparities in mortality lessened during the pandemic, possibly due to standardized interventions and the physiological effects of SARS-CoV-2. The link between occupation and obesity highlighted how work environments impact trauma severity, especially as lifestyle changes affect BMI. While age remained a major predictor of mortality, its influence slightly decreased, potentially due to improved protocols for elderly patients. RDW emerged as an important prognostic marker for disease severity and mortality risk.

CONCLUSIONS

Employing advanced co-occurrence analysis enhanced with machine learning, we uncovered complex relationships between clinical and demographic variables often overlooked by traditional methods. This innovative approach provided deeper insights into the collective impact of various factors on patient outcomes. Our findings demonstrate the healthcare system's rapid adaptations during the pandemic and offer critical insights for optimizing medical strategies and developing personalized interventions in global crises.

Epidemiological analysis of 2106 geriatric trauma patients in a level I trauma center in Lanzhou City, Gansu Province, China

As the global population ages, geriatric trauma gains attention. Limited studies on geriatric trauma in developing countries necessitate comprehensive investigation. This study aims to delineate the epidemiological characteristics of geriatric trauma, providing insights for prevention and enhanced elderly trauma care. Clinical data of 2106 geriatric trauma patients (age ≥ 60) treated from November 1, 2020, to October 31, 2023, at the trauma center of the First Hospital of Lanzhou University were retrospectively analyzed. Descriptive statistics covered temporal and monthly distribution, trauma sites, causes, and length of stay. Inclusive were 2106 geriatric patients (941 males, 1165 females; male-to-female ratio 1:1.24). Trauma incidence was higher in summer and autumn (May-October) than winter (November-December). Peak incidents occurred between 14:00-16:00, with concentrations at 12:00-16:00 and 20:00-22:00. Falls (59.35%), road traffic accidents (16.62%), other traumas (14.10%), cutting/stabbing (4.56%), violence (3.42%), mechanical injuries (1.61%), winter sports injuries (0.14%), burns (0.14%), and animal bites (0.06%) were major causes. Extremity and skin injuries prevailed, with significant site distribution differences (P < .001). Average length of stay at the trauma center was 78.35 ± 48.32 minutes. The gender distribution, timing, causes, and sites of trauma in the elderly differ significantly from other age groups. Unlike the higher occurrence of trauma in young men compared to women, among the elderly, it is more prevalent in women than men, mainly attributed to falls. It is crucial to implement specific measures to prevent trauma in the elderly, and the advancement of information technology in the trauma care system could additionally improve the quality of care.

Prehospital undertriage of older injured patients in western Switzerland: an observational cross-sectional study

BACKGROUND

The ageing of the population is leading to an increase in the number of traumatic injuries and represents a major challenge for the future. Falls represent the leading cause of Emergency department admission in older people, with injuries ranging from minor to severe multiple injuries. Older injured patients are more likely to be undertriaged than younger patients. The aim of this study was to investigate the extent of undertriage in older patients with particular emphasis on access to trauma centres and resuscitation rooms.

METHODS

Retrospective observational cross-sectional study based on data prospectively collected from prehospital electronic records including all patients ≥ 18 years for whom an ambulance or helicopter was dispatched between 1 January 2018 and 31 April 2023 due to a trauma. The primary outcome, admission to the resuscitation room of the regional trauma centre with trauma team activation, was assessed by age. Multivariate logistic regression was used to control for known confounders and to test for plausible effect modifiers.

RESULTS

Emergency Medical Services treated 37,906 injured patients. Older patients ≥ 75 years represented 17,719 patients (47%). Admission to trauma centre with trauma team activation was lower in older patients, N = 121 (1%) compared to N = 599 (5%) in younger patients, p < 0.001; adjusted odds ratio: 0.33 (0.24-0.45); p < 0.001. Undertriage increased by twofold with age ≥ 75; OR: 1.81 (1.04-3.15); p value < 0.001. Undertriaged patients were older, more likely to be female, to have low energy trauma and to be located farther from the regional trauma centre.

CONCLUSION

Older injured patients were at increased risk of undertriage and non-trauma team activation admission, especially if they were older, female, had head injury without altered consciousness and greater distance to regional trauma centre.

Acute Gastrointestinal Injury in Polytrauma: Special Attention to Elderly Patients

Background: Acute gastrointestinal injury (AGI) has been documented in critically ill patients, yet there remains a dearth of knowledge regarding its occurrence, predisposing factors, and outcomes in elderly polytrauma patients, a significant but overlooked population. This study aims to examine the frequency, risk factors, and clinical implications of AGI in elderly polytrauma patients. Methods: A retrospective, observational, multicenter study was carried out in two Level I trauma centers, encompassing a cohort of 1054 polytrauma patients from July 2020 to April 2022. Results: A total of 965 consecutive polytrauma patients were recruited who were divided into youth group (n=746) and elderly group (n=219). 73.5% of elderly patients after polytrauma were accompanied by AGI. An increasing ISS (OR=2.957, 95%CI: 1.285-7.714), SI (OR=2.861, 95%CI: 1.372-5.823), serum lactate (OR=2.547, 95%CI: 1.254-5.028), IL-6 (OR=1.771, 95%CI: 1.145-8.768), APTT (OR=1.462, 95%CI: 1.364-4.254) and a decreasing GCS (OR=0.325, 95%CI: 0.116-0.906) were each associated with an increasing risk of AGI in elderly polytrauma patients. Elderly polytrauma patients with AGI were presented relatively high 28-day mortality (40.4%) and super high 60-day mortality (61.2%) compared with elderly group without AGI and youth group with AGI. The area under the curve for predicting 28-day mortality in elderly polytrauma patients with AGI was 0.93 for AGI-III,IV with 96% sensitivity and 87% specificity. Conclusion: Elderly patients have a higher incidence and a worse prognosis of AGI after polytrauma. ISS, GCS, SI, serum lactate, IL-6, and APTT are identified as reliable prognostic markers to distinguish the AGI and N-AGI in elderly polytrauma patients. AGI-III,IV was the independent predictor of mortality in elderly polytrauma patients with AGI.

Prediction of Neurological Outcomes in Elderly Patients With Head Trauma Using the Geriatric Trauma Outcome Score: A Retrospective Observational Study

Introduction Head trauma in elderly people is a problem in today's aging society. Elderly people are susceptible to head trauma because of their declining physical function; this tends to be severe. Outcome prediction is important in decision-making regarding treatment strategies; however, there is no unified method for predicting neurological outcomes in elderly patients with head trauma. Methods Elderly patients with head trauma admitted to the Japan Red Cross Narita Hospital between January 2019 and August 2023 were enrolled in this single-center, retrospective observational study. A favorable neurological outcome was defined as a cerebral performance category scale of 1 or 2. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to investigate the association between geriatric trauma outcome scores and outcomes and to evaluate the predictive value of geriatric trauma outcome scores. The primary outcome was a favorable neurological outcome at discharge, and the secondary outcome was in-hospital mortality. Results A total of 313 elderly patients with head trauma were eligible for analysis. Multivariate logistic regression analysis revealed that the geriatric trauma outcome score was significantly associated with a favorable neurological outcome at discharge (odds ratio 0.94, P <0.0001). In the receiver operating characteristic curve analysis, the geriatric trauma outcome score had a good predictive value for favorable neurological outcomes at discharge (area under the receiver operating characteristic curve 0.83). Conclusions The geriatric trauma outcome score had good predictive value for favorable neurological outcomes at discharge in elderly patients with head trauma and has the potential to aid in decision-making regarding treatment strategies for elderly patients with head trauma.

World trends in publication for maxillofacial and dental trauma in the elderly

Aging may increase the risk of maxillofacial and dentoalveolar trauma (MDT). This review assessed global trends in scientific publications on MDT in the elderly. Six databases were searched. Studies about MDT in the elderly (≥60 years old) were included in two text mining stages (S1 and S2). In S1, all studies with elderly subjects were included, while in S2 only studies in which the elderly were assessed in a separate set of data or in a subanalysis by age groups were included. In S1, relevant data were mined using VantagePoint™ software. In S2, data were descriptively analyzed. There were 2265 studies at S1 and 110 at S2. The publication dates spanned from 1963 to 2023. In S1, the most cited keywords and terms were aged (n = 1872), male (n = 1839), female (n = 1777), "mandible fracture" (n = 460), "orbit fracture" (n = 362), and "maxilla fracture" (n = 118). Thirty authors published 10 or more articles with visible collaboration networks. There was a progressive increase in publications, especially in Europe (n = 150). In S2, most studies were case reports/case series (n = 62). The primary etiology was accidental falls (n = 84), the most affected region was the middle third of the face (n = 65), and dental trauma was rarely reported (n = 15). Cone Beam computed tomography was the most used diagnostic tool (n = 67). Of the 81 articles that addressed therapy, 52 opted for surgical treatment. Although there has been an increase in the number of articles on MDT over the years, studies with the elderly population as a specific study group are still needed. Accidental falls were the most reported etiology, while the middle third of the face and the mandible were the anatomic region and bone most affected, respectively. The high number of case reports indicates the need for improvement in the available scientific evidence about MDT in the elderly.

Exploring geriatric trauma unit experiences through patients' eyes: a qualitative study

INTRODUCTION

The surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit's emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization.

METHODS

This qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed.

RESULTS

The findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit.

CONCLUSION

Effective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.

Epidemiological profile of patients undergoing non-operative management of solid organ injury and associated factors with mortality

INTRODUCTION

Trauma primarily affects the economically active population, causing social and economic impact. The non-operative management of solid organ injuries aims to preserve organ function, reducing the morbidity and mortality associated with surgical interventions. The aim of study was to demonstrate the epidemiological profile of patients undergoing non-operative management in a trauma hospital and to evaluate factors associated with mortality in these patients.

METHODS

This is a historical cohort of patients undergoing non-operative management for solid organ injuries at a Brazilian trauma reference hospital between 2018 and 2022. Included were patients with blunt and penetrating trauma, analyzing epidemiological characteristics, blood transfusion, and association with the need for surgical intervention.

RESULTS

A total of 365 patients were included in the study. Three hundred and forty-three patients were discharged (93.97%), and the success rate of non-operative treatment was 84.6%. There was an association between mortality and the following associated injuries: hemothorax, sternal fracture, aortic dissection, and traumatic brain injury. There was an association between the need for transfusion and surgical intervention. Thirty-eight patients required some form of surgical intervention.

CONCLUSION

The profile of patients undergoing non-operative treatment consists of young men who are victims of blunt trauma. Non-operative treatment is safe and has a high success rate.

Challenges to conducting research on oral health with older adults living in long-term care facilities

BACKGROUND

The challenges to conducting oral health studies involving older people in long-term care facilities (LTCFs) must be debated.

OBJECTIVE

This study aimed to investigate researchers' perceptions and experiences while conducting an epidemiological survey on oral health among older individuals residing in LTCFs.

METHODS

A qualitative study was conducted involving six researchers who utilized field diaries to record their impressions during data collection through interviews (older individuals (or their proxies), caregivers, and LTCF coordinators) and oral examinations of the older people participants. Additionally, researchers responded to open-ended questions about their experiences. The collected material was subjected to content analysis by two researchers.

RESULTS

The themes that emerged from the analysis were institutional context, aspects affecting the operationalization of the study, and data collection oriented by the clinical-functional profile of the older people. According to the researchers' perceptions, LTCF coordinators demonstrated concern for the study's benefits for older adults and the preservation of institutional routines during the research process. Caregivers emerged as vital sources of information, guiding researchers in navigating the challenges posed by the physical and mental complexities of the older people participants, necessitating empathy, sensitivity, and attentive listening from the researchers. The organization of materials and a streamlined data collection process proved essential for optimizing time efficiency and reducing stress for participants and researchers.

CONCLUSION

The researchers recognized the important role played by LTCF coordinators and formal caregivers, underscoring the significance of empathetic methodologies and streamlined data collection processes in mitigating the challenges inherent to research conducted within LTCFs.

Risk Factors Analysis for 90-Day Mortality of Adult Patients with Mild Traumatic Brain Injury in an Italian Emergency Department

Purpose: The most prominent risk factors for mortality after mild traumatic brain injury (TBI) have not been established. This study aimed to establish risk factors related to 90-day mortality after a traumatic event. Methods: A retrospective cohort study on adult patients entering the Emergency Department of the University Hospital of Trieste for mild TBI from 1 January 2020 to 31 December 2020 was conducted. Results: The final population was 1221 patients (median age of 78 years). The 90-day mortality rate was 7% (90 patients). In the Cox regression model (likelihood ratio 110.9; p < 2 × 10-16), the variables that significantly correlated to 90-day mortality were age (less than 75 years old is a protective factor, HR 0.29 [95%CI 0.16-0.54]; p < 0.001); chronic liver disease (HR 4.59 [95%CI 2.56-8.24], p < 0.001); cognitive impairment (HR 2.76 [95%CI 1.78-4.27], p < 0.001); intracerebral haemorrhage (HR 15.38 [95%CI 6.13-38.63], p < 0.001); and hospitalization (HR 2.56 [95%CI 1.67-3.92], p < 0.001). Cardiovascular disease (47% vs. 11%; p < 0.001) and cognitive impairment (36% vs. 10%; p < 0.001) were more prevalent in patients over 75 years of age than the rest of the population. Conclusions: In our cohort of patients with mild TBI, 90-day mortality was low but not negligible. The risk factors associated with 90-day mortality included age, history of chronic liver disease, and cognitive impairment, as well as evidence of intracerebral hemorrhage and hospitalization. The mortality of the sub-population of older patients was likely to be linked to cardiovascular comorbidities and neurodegenerative diseases.

Impact of COVID-19 Lockdown on Traumatic Bone Fracture Patterns and Hospital Outcomes in 1646 Elderly Patients: A Retrospective Study in Turkey

BACKGROUND During the Coronavirus Disease-2019 (COVID-19) pandemic-related lockdowns, modifications in trauma-related behavior and other factors in the elderly population may have occurred. The present retrospective study aimed to compare outcomes from emergency admissions to a major trauma center in Turkey of 1646 elderly patients with traumatic bone fractures that occurred before, during, and after the COVID-19 pandemic lockdown period. MATERIAL AND METHODS A cohort of 1646 elderly trauma patients admitted between September 15, 2019 and September 15, 2020 were retrospectively scanned from the hospital registry system and were grouped as admitted during the COVID-19 pandemic before (Group 1), during (Group 2), or after (Group 3) the lockdown restrictions. Demographic and clinical data were examined by making comparisons between the 3 groups. RESULTS In all groups, female sex was more prevalent. Fractures were more common in the ulna and femur than in other bones (P=0.026, P=0.035). Among the groups, in Group 2, injuries due to the mechanism of falling from one's own height on the ground were more prominent (79.2%). Hospital costs were lower in Group 1 (P<0.001). The majority of hospitalized patients (n=874; 53.1%) were in Group 2 (P=0.009). CONCLUSIONS During pandemic lockdowns, the mechanism of falling from one's own height was more common in the elderly population. The ulna and femur were the predominant bones fractured. Therefore, during lockdown periods, precautions should be taken to prevent the elderly from falling from their own height.

Reality of treatment for severely injured patients: are there age-specific differences?

BACKGROUND

Major trauma and its consequences are one of the leading causes of death worldwide across all age groups. Few studies have conducted comparative age-specific investigations. It is well known that children respond differently to major trauma than elderly patients due to physiological differences. The aim of this study was to analyze the actual reality of treatment and outcomes by using a matched triplet analysis of severely injured patients of different age groups.

METHODS

Data from the TraumaRegister DGU® were analyzed. A total of 56,115 patients met the following inclusion criteria: individuals with Maximum Abbreviated Injury Scale > 2 and < 6, primary admission, from German-speaking countries, and treated from 2011-2020. Furthermore, three age groups were defined (child: 3-15 years; adult: 20-50 years; and elderly: 70-90 years). The matched triplets were defined based on the following criteria: 1. exact injury severity of the body regions according to the Abbreviated Injury Scale (head, thorax, abdomen, extremities [including pelvis], and spine) and 2. level of the receiving hospital.

RESULTS

A total of 2,590 matched triplets could be defined. Traffic accidents were the main cause of severe injury in younger patients (child: 59.2%; adult: 57.9%). In contrast, low falls (from < 3 m) were the most frequent cause of accidents in the elderly group (47.2%). Elderly patients were least likely to be resuscitated at the scene. Both children and elderly patients received fewer therapeutic interventions on average than adults. More elderly patients died during the clinical course, and their outcome was worse overall, whereas the children had the lowest mortality rate.

CONCLUSIONS

For the first time, a large patient population was used to demonstrate that both elderly patients and children may have received less invasive treatment compared with adults who were injured with exactly the same severity (with the outcomes of these two groups being opposite to each other). Future studies and recommendations should urgently consider the different age groups.

The Etiology of Trauma in Geriatric Traumatic Patients Refer to an Academic Trauma Center: A Cross Sectional Study

Objective

Geriatric trauma refers to injuries sustained by elderly individuals, typically those aged 65 years and older. The management of geriatric trauma in the Emergency Department requires a comprehensive approach that takes into account the physiological changes associated with aging, as well as the increased vulnerability and complexity of injuries in this population.

Methods

This is a cross-sectional study aimed at evaluating the etiology of trauma in geriatric patients referred to the ED of level-1 an academic center. All patients with complaints of trauma are evaluated and patients over 65 years enrolled in the study. Data were analyzed by SPSS 26.

Results

319 patients were investigated, 49.8% male and 50.2% female. The most common underlying diseases are high blood pressure, diabetes type 2, and ischemic heart disease. The most common trauma cause was falling from the same level (48.9%), followed by a fall from a height (16.6%), accidents with cars (16%), and motorcycles (9.1%). The most common injury was extremities trauma (71.5%) following head trauma (13.2%) and chest trauma (6%). The severity of injury in extremities was higher in women, and chest trauma was more severe in men.

Conclusion

The fall and subsequent car accident had the highest frequency as a cause of trauma in elderly patients admitted to our academic trauma center. Hypertension and diabetes have also been the most common underlying diseases. Head and neck injuries are life-threatening and critical in a larger number of patients than other injuries, and protecting them can be effective in reducing mortality and serious injuries in elderly trauma patients.

[Bicycle accidents in the course of time in Münster, Germany : Analysis of changes in bicycle accidents over the past 10 years]

BACKGROUND

Bicycles have been a popular means of transport for many years. Especially in times of increased climate discussion, the bicycle has moved further into focus as an environmentally friendly and cost-effective means of transport. Bike lanes and roads are becoming more crowded and new means of transport such as pedelecs or e‑scooters are emerging.

METHODS

A total of four studies by Münster University Hospital on bicycle accidents and the official accident statistics of the Münster police were compared. In the period from 2009 to 2019, three studies were conducted that considered all bicycle accidents and one study that only considered pedelec riders separately.

RESULTS

The age distribution as well as main causes of accidents remained almost the same over the years. The number of pedelec accidents has increased. Pedelec riders have a higher average age and a higher proportion of intensive care stays; however, this cohort also has a high rate of helmet wearers. Overall, the willingness to wear a helmet seems to have increased.

CONCLUSION

It should be considered that with increasing bicycle traffic, safety measures must be increased accordingly. In this respect, accident prevention should focus on three major areas, engineering, education and enforcement.

Serum Levels of Pro-Brain Natriuretic Peptide and the Diagnosis and Prognosis of Cardiac Syncope

Objective

Recently, different serum markers have been used for the diagnosis and prognosis of acute heart diseases in emergency departments. To determine such a role, the present study was designed and conducted.

Methods

This is an analytical cross-sectional study conducted on patients with syncope complaints. The patients enrolled in the study based on the inclusion and exclusion criteria and underwent initial evaluations, including collecting a history, physical examination, ECG, blood sugar measurement, and, if necessary, brain CT scan, Doppler echocardiography, and CTA.

Results

This study included 100 participants who complained of syncope. The results showed that 19% and 81% of the subjects suffered from cardiac and non-cardiac syncope, respectively. The average Pro BNP of the studied individuals was 196.06±128.45 pg/mL. According to the results, age and length of hospitalization had a positive and significant relationship with the average Pro BNP (p<0.01). Individuals with positive TPI, cardiac syncope, and abnormal ECG or Doppler findings had significantly higher average Pro BNP levels (p<0.01). The results of the diagnostic value of Pro BNP in diagnosing cardiac syncope also showed that its sensitivity and specificity were 94.73% and 56.79%, respectively.

Conclusion

The results of this study showed that the increase in the Pro BNP values was associated with age, length of hospitalization, and ECG abnormalities. In addition, as an independent marker, Pro BNP had optimal acceptability in identifying cardiac syncope cases.

Appropriate Imaging for Geriatric Trauma

BACKGROUND

Trauma is the leading cause of preventable death in the United States. Early detection of life-threatening injuries leads to improved survival. Computed tomography (CT) scanning has become the modality of choice for early detection of injuries in the stable patient. Some studies have associated selective imaging (Selective-CT) with equivalent outcomes compared to whole body imaging (Pan-CT) with lower costs and radiation exposure. Within the geriatric population, however, the utility of Pan-CT remains controversial. Therefore, the aim of this study was to determine if a difference exists between Selective-CT and Pan-CT imaging in the geriatric trauma patient.

METHODS

A retrospective analysis of Level 3 (G60) trauma activations presenting to our urban Level I trauma center between June 2016 and June 2019 was performed. Pan-CT was defined by ICD-10 codes indicating a head, cervical spine, chest, abdomen, and pelvis CT series. Patients with missing images and those who were transferred from other institutions were excluded. Logistic regression controlling for age, gender, injury type, severity, and Glasgow Coma Score was performed.

RESULTS

A total of 1014 patients met inclusion criteria. Of these, 30.9% underwent Pan-CT (n = 314), 48.9% had Selective-CT (n = 497), and 20.2% received no CT imaging (n = 203). After logistic regression, no clinically significant variations in emergency department length of stay (LOS), hospital LOS, ICU LOS, ventilator days, discharge disposition, missed injury rate, or mortality rate were observed between imaging strategies.

CONCLUSIONS

Pan-CT provides no clinically significant advantage over Selective-CT in the geriatric trauma patient.

[Analysis of risk factors for dropping out of residency in orthopedics and trauma surgery]

BACKGROUND

Currently, there are no data available on dropouts from residency programs and changes of clinic in orthopedics and trauma surgery (O&T). The aim of the study is to identify personal and structural risk factors leading to dropout or switching of postgraduate training in O&T in order to present solution strategies.

METHODS

A nationwide anonymous online survey was conducted among residents in O&T in summer 2020. Official mail addresses were identified via the Traumanetzwerk© of the DGU and the German Hospital Federation (n = 2090). A questionnaire (51 questions) was administered using SurveyMonkey (San Mateo, CA, USA). All residents who worked in O&T for at least 1 month in the 6 years prior to the start of the survey (from 07/2014) were eligible to participate. A binary logistic regression was calculated to identify the risk factors. The significance level was p = 0.05.

RESULTS

Of the 221 respondents, 37% switched hospital and 5% dropped out altogether. The regression revealed 3 significant risk factors for switching hospitals. Living in a partnership (p = 0.029, RR: 2.823) and less than 2 days of shadowing before the start of residency (p = 0.002, RR: 2.4) increased the risk of switching. Operating room (OR) allocation of residents according to the training plan/status (p = 0.028, RR: 0.48) reduces the risk of switching. Significant risk factors for leaving postgraduate training could not be determined (insufficient number of cases, n = 11).

DISCUSSION

Switching the hospital and residency dropouts in O&T are a relevant problem (42%). Gender has no significant influence. Tools such as longer job shadowing, as well as OR allocation according to the training plan/status can minimize the risk of switching.

Follow-up analysis of quality of life in elderly patients with bone trauma: a longitudinal observational study

BACKGROUND

The quality of life (QoL) of elderly patients with bone trauma is significantly decreased and is affected by many complex factors. This study aims to conduct a half-year follow-up survey to clarify QoL and its influencing factors in elderly patients with bone trauma in order to provide targeted care measures for elderly patients with bone trauma.

METHODS

This was a longitudinal observational study. We used the 36-Item Short Form Health Survey (SF-36) to investigate and evaluate the QoL of 100 patients with bone trauma at the time of hospital discharge and 1 month, 3 months, and 6 months after discharge. Our previous study confirmed that the SF-36 had higher reliability and validity for evaluating the QoL of elderly patients with bone trauma. At the same time, we also investigated the age, gender, location of bone trauma, and destination after discharge of those patients. Those factors that might affect the QoL of elderly patients with bone trauma were identified by univariate and multivariate analyses.

RESULTS

The total physiological function, role-physical, bodily pain, vitality, social functioning, role-emotional, and mental health scores of elderly patients with bone trauma gradually increased from the time of discharge to 1 month, 3 months, and 6 months after discharge, and there were significant differences (p < 0.001). However, there was no significant difference in the general health score in the different periods (P = 0.095). The total QoL scores also significantly differed (F = 118.61, P < 0.001) at the time of discharge (335.252 ± 127.572) and 1 month (285.149 ± 112.827), 3 months (479.344 ± 153.663), and 6 months after discharge (544.396 ± 166.536). The univariate analysis results showed that the location of bone trauma (P < 0.005) and the destination after discharge (P < 0.001) were the main factors affecting QoL in different periods. The results of the multivariate analysis showed that the location of bone trauma was an important factor affecting QoL (P < 0.005 in different periods). Whether to undergo surgery was a factor affecting the patients' long-term QoL (P < 0.005 at 6 months after discharge).

CONCLUSIONS

Although the QoL of elderly patients with bone trauma gradually improves after injury, their recovery time is long, and the influencing factors are complex. Follow-up services should continue for at least six months for these patients, and comprehensive treatment and long-term rehabilitation services should be provided.

Analysis of Trauma Characteristics Between the Older and Younger Adult Patient from the Pan Asian Trauma Outcome Study Registry (PATOS)

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.

Evaluation of factors affecting prognosis and mortality in geriatric patients presented to the emergency service with head trauma

Objective

Head trauma, a cause of serious morbidity and mortality in general, is among the most common causes of emergency department visits in geriatric patients. In this context, this study investigated the factors affecting prognosis and mortality in geriatric patients presenting with head trauma at the emergency department.

Methods

This retrospective cohort study included 842 patients aged 65 years and above who presented with head trauma to the emergency department between January 1, 2019, and December 31, 2019. Demographic and clinical data of the 622 patients included in the study were analyzed.

Results

A total of 622 geriatric patients with head trauma were included in this study. Of these, 54.2% (337/622) were men, and 45.8% (285/622) were women. The mean age of the patients was 75.3 ± 7.5 years. Antihypertensives were the most common medications taken by the patients. Subdural hematoma is the most frequently observed cranial pathology. A simple fall is the most observed mechanism for trauma. A total of 17.5% (109/622) of the patients were admitted to the hospital. Of these patients, 8.4% (52/622) were transferred to the intensive care unit and 2.6% (16/622) of the patients died.

Conclusion

Mortality would be expected to be higher in elderly patients with head trauma, hypotension, or high lactate levels. The need for intensive care unit transfer was higher in patients with coronary artery disease. The mortality rate of the patients increased with an increasing length of hospital stay.

Retrospective In-Hospital Mortality Analysis of GeriatricPatients Treated in a Level 1 Trauma Center

The aim of this study is to determine the critical time intervals and influencing covariates for in-hospital mortality in geriatric trauma and orthopedic patients. During a period of five years, we retrospectively review patients aged > 60 years who were hospitalized at the Department of Trauma, Orthopedic, and Plastic Surgery. The primary outcome is the mean time to death. Survival analysis is performed using an accelerated failure time model. A total of 5388 patients are included in the analysis. Two-thirds underwent surgery (n = 3497, 65%) and one-third were conservatively treated (n = 1891, 35%). The in-hospital mortality rate is 3.1% (n = 168; surgery, n = 112; conservative, n = 56). The mean time to death is 23.3 days (±18.8) after admission in the surgery group and 11.3 days (±12.5) in the conservative treatment group. The greatest accelerating effect on mortality is found in the intensive care unit (16.52, p < 0.001). We are able to identify a critical time interval for in-hospital mortality between days 11 and 23. The day of death on weekend days/holidays, hospitalization for conservative treatment, and treatment at the intensive care unit significantly increase the risk of in-hospital mortality. Early mobilization and a short hospitalization duration seem to be of major importance in fragile patients.

The modified 5-item frailty index determines the length of hospital stay and accompanies with mortality rate in patients with bone and implant-associated infections after trauma and orthopedic surgery

BACKGROUND

Bone and implant-associated infections are severe complications after trauma and orthopedic surgery. The modified 5-item frailty index (mFI-5) is an easily applicable score to predict adverse outcome after surgery. The current literature regarding mFI-5 is focused on a period of 30-days postoperative.

PURPOSE

This study aims to assess the impact of frailty in orthopedic trauma patients with bone and implant-associated infections. mFI-5 was calculated from a database, which prospectively collects data about factors potentially correlated with peri- and postoperative complications since 2014.

METHODS

In a level I trauma center a total of 345 patients with surgical site infections were enrolled in this study. Hereof, patients with fracture-related infections after osteosynthesis, periprosthetic joint infections of the hip and knee and post-operative osteomyelitis were included. Extensive medical baseline examination was performed in 2013/14, a three-year follow-up was organized as a telephone interview. The mFI-5 score was calculated based on the 5 factor-principle as established by Subramaniam. The nutritional status was assessed using the Nutritional Risk Screening (NRS-2002).

RESULTS

130 patients were included, whereof seven had died, resulting in 123 patients. A grouping of our patients was performed in mFI-5 = 0 (n = 46; 36,4%), mFI-5 = 1 (n = 41; 33,3%) or mFI-5 ≥ 2 (n = 36; 29,3%). Sex distribution showed 69,1% male and 30,9% female patients. Frailty did neither impact on the re-admission (p = 0,433) nor the reoperation (p = 0,327) rate in our cohort. The mortality risk nearly doubled (1,7 times) in frail patients, but did not reach significance. In hospital stay was prolonged due to frailty (12,1 ± 11,8; p = 0,004) compared to those with a mFI-5 = 0 (5,9 ± 5,1) or mFI-5 = 1 (6,9 ± 5,9). Frailty goes along with a risk of malnutrition and increases with age.

CONCLUSION

The modified 5-item frailty index is not a suitable screening tool for predicting revision rate, re-admission rate, and mortality in our orthopedic trauma patient population with bone and implant-associated infections. Nevertheless, frailty is associated with an increased risk of malnutrition and increases with age.

Enzymatic Debridement in Geriatric Burn Patients—A Reliable Option for Selective Eschar Removal

The treatment of geriatric burn patients represents a major challenge in burn care. The objective of this study was to evaluate the efficacy of enzymatic debridement (ED) in geriatric burn patients. Adult patients who received ED for treatment of mixed pattern and full thickness burns (August 2017–October 2022) were included in this study and grouped in the younger (18–65 years) and geriatric (≥65 years) groups. Primary outcome was a necessity of surgery subsequent to ED. Both groups (patient characteristics, surgical and non-surgical treatment) were compared. Multiple logistic and linear regression models were used to identify the effect of age on the outcomes. A total of 169 patients were included (younger group: 135 patients, geriatric group: 34 patients). The burn size as indicated by %TBSA (24.2 ± 20.4% vs. 26.8 ± 17.1%, p = 0.499) was similar in both groups. The ASA (2.5 ± 1.1 vs. 3.4 ± 1.1, p < 0.001) and ABSI scores (6.1 ± 2.8 vs. 8.6 ± 2.3, p < 0.001) were significantly higher in the geriatric group. The %TBSA treated with ED (5.4 ± 5.0% vs. 4.4 ± 4.3%, p = 0.245) were similar in both groups. The necessity of additional surgical interventions (63.0 % vs. 58.8 %, p = 0.763) and the wound size debrided and grafted (2.9 ± 3.5% vs. 2.2 ± 2.1%; p = 0.301) were similar in both groups. Regression models yielded that age did not have an effect on efficacy of ED. We showed that ED is reliable and safe to use in geriatric patients. Age did not have a significant influence on the surgical outcomes of ED. In both groups, the size of the grafted area was reduced and, in many patients, surgery was avoided completely.

Are we waiting for the sky to fall? Predictors of withdrawal of life-sustaining support in older trauma patients: A retrospective analysis

BACKGROUND

Limited data exist regarding the impact of advanced care planning for injured geriatric patients. We hypothesized that patients with advance directives limiting care (ADLC) compared with those without ADLC are more likely to undergo withdrawal of life-sustaining support (WLSS).

METHODS

This is a propensity-matched analysis utilizing American College of Surgeons Trauma Quality Improvement Program patients 65 years or older who presented between 2017 and 2018. Patients with and without ADLC on admission were compared. The primary outcome was WLSS and days prior to WLSS. Additional factors examined included hospital length of stay (LOS), unplanned operations, unplanned intensive care unit admissions, and in-hospital cardiac arrests. Prior to matching, logistic regression model assessed factors associated with WLSS. Patients with and without ADLC were matched 1:1 via a propensity score using patient and injury factors as covariates, and matched pair analysis compared differences in WLSS between patients with and without ADLC.

RESULTS

There were 597,840 patients included: 44,001 patients with an ADLC (7.36%) compared with 553,839 with no ADLC (92.64%). Patients with an ADLC underwent WLSS more often than those with no ADLC (7.68% vs. 2.48%, p < 0.001). In a 1:1 propensity-matched analysis, patients with ADLC were more likely to undergo WLSS (odds ratio [OR], 2.38' 95% confidence interval [CI], 2.22-2.55), although stronger predictors of WLSS included severity of injury (Injury Severity Score, 25+; OR, 23.84; 95% CI, 21.55-26.36), unplanned intensive care unit admissions (OR, 3.30; 95% CI, 2.89-3.75), and in-hospital cardiac arrests (OR, 4.97; 95% CI, 4.02-6.15).

CONCLUSION

A small proportion of the geriatric trauma population had ADLC on admission. While ADLC was predictive of WLSS, adverse events were more strongly associated with WLSS. To ensure patient-centered care and reduce futile interventions, surgeons should delineate goals of care early regardless of ADLC.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.

Comparing rates of skull fractures in female versus male geriatric patients who sustain head injuries

BACKGROUND

Head trauma is the leading cause of serious injury in the older adult population with skull fractures as a serious reported outcome. This study aims to evaluate the role of sex in the risk of skull fracture in patients over the age of 65.

METHODS

A prospective cohort study was conducted at two level-one trauma centers, serving a population of 360,000 geriatric residents. Over a year-long period, consecutive patients aged 65 years and older who presented with blunt head injury were included. Patients who did not receive head CT imaging were excluded. The primary outcome was rate of skull fracture due to the acute trauma, compared by sex. Additional factors examined included patient race/ethnicity and mechanism of injury.

RESULTS

Among 5402 patients enrolled, 3010 (56%) were female and 2392 (44%) were male. 4612 (85%) of the head injuries sustained were due to falls, and 4536 (90%) of all subjects were Caucasian. Overall, 199 patients (3.7%) sustained skull fractures. Males had a significantly greater rate of skull fracture when compared to females (4.6% vs 3.0%, OR 1.5, 95% CI: 1.2-2.1, p = 0.002). This trend was also seen across race/ethnicity and mechanism of injury.

CONCLUSIONS

Older males were found to have a higher rate of skull fractures compared to females after sustaining blunt head trauma, mostly due to falls.

Musculus psoas major morphology - a novel predictor of mortality in elderly polytraumatized patients

INTRODUCTION

Numerous papers in different fields have already shown that CT imaging of the Musculus Psoas Major (MPM) can be used to predict patient outcome. Unfortunately, most of the methods presented in the literature are very complex and not easy to perform in the clinic. Therefore, the objectives of the study were to introduce a novel and convenient method for measuring the MPM to trauma surgeons and to prove the association between MPM morphology and mortality in elderly polytraumatized patients.

MATERIAL AND METHODS

The retrospective outcome study was conducted at our level I trauma center. All patients admitted from 2006 to 2020 were included if they (1) presented with multiple injuries (≥2 body regions) and an Injury Severity Score (ISS) ≥16, (2) were at least 65 years of age, and (3) were diagnosed using a whole-body computed tomography. Subsequently, the ratios of short-axis to long-axis of both MPM were measured, and their mean value was evaluated as a candidate predictor of 31-day mortality.

RESULTS

Our study group consisted of 158 patients (63.3% male; median age, 76 years; median ISS, 25). In the survivors (55.7%), the mean MPM score was significantly higher compared to the fatalities (0.57 versus 0.48; p < 0.0001). Multivariate binary logistic regression analysis identified the MPM score as a protective predictor of 31 day-mortality (OR = 0.92, p < 0.001), whereas age (OR 1.08, p = 0.002 and ISS (OR 1.06, p = 0.006) revealed as significant risk factors for mortality. ROC statistics provided an AUC = 0.724 (p < 0.0001) and a cut-off level of 0,48 (sensitivity, 80.7%; specificity, 54.3%).

CONCLUSION

The present study demonstrated that MPM score levels lower than 0.48 might be considered an additional tool to identify elderly patients at high risk of death following major trauma. In our opinion, the assessment of the MPM score is an easy, convenient, and intuitive method to gain additional information quickly after admission to the hospital that could be implemented without great effort into daily clinical practice.

Domestic Cow-Related Severe Facial Trauma in an Older Farmer Undergoing Anticoagulation Treatment

Domestic cow-related injuries can carry significant morbidity and mortality among livestock farmers. We report a case of an 83-year-old male farmer with severe facial trauma and a potentially compromised airway caused by a domestic dairy cow during his routine work while taking oral anticoagulants. Since head and neck trauma caused by domestic cows can be severe, preventive measures should be taken to protect cattle farmers in those exposed areas.

Major trauma associated with mobility scooters: An analysis of the trauma audit research network

AIMS

To establish the incidence and nature of injuries seen in patients following mobility scooter incidents.

METHODS

The Trauma Audit and Research Network (TARN) database was used to collect data concerning injuries associated with mobility scooters. The data was taken from incidents that occurred between February 2014 and November 2020. The data analysed included: patient demographics, injury mechanism and patterns and associated mortality rates.

RESULTS

1,504 patients were identified of which 61.4% were male. The median age was 76.2 years (IQR 63.5-84.9). The median injury severity score (ISS) was 9 (IQR 9-17), with major trauma (ISS ≥16) being observed in 29.4% of patients. Injuries to the limb were most common, although injuries to the head were most severe. Vehicle collisions accounted for 65.4% of injuries and were most closely associated with the most severe incidents. The median length of stay in hospital was 12 days, excluding the patients who died. Overall, mortality following injury was 10.6%, but the mortality rate was 15.4% in those aged 75 years and over, and 24.2% in those sustaining severe trauma.

CONCLUSION

As the population ages, injury characteristics of those with both major and non-major trauma changes. Mobility scooter use is prevalent amongst older people, and we provided a detailed analysis of injuries sustained with their use across a national database. The length of stay and the inherent resource use, because of admission following mobility scooter trauma, is considerable. These injuries particularly affect the 'most elderly' and carry a considerable mortality burden.

The Association of Gender and Mortality in Geriatric Trauma Patients

The association of gender with mortality in trauma remains a subject of debate. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of gender with mortality in a group of geriatric trauma patients presenting to an academic level 1 trauma center (trauma center designated by New York State capable of handling the most severe injuries and most complex cases). Methods: We performed a retrospective review of geriatric trauma patients who were admitted to our trauma center between January 2018 and December 2020. Data collected included vital signs, demographics, injury, and clinical characteristics, laboratory data and outcome measures. The study controlled for co-morbidities, injury severity score (ISS), and systolic blood pressure (SBP) in the ED. Multivariable logistic regression analysis was performed to evaluate the association of gender and mortality. Results: 4432 geriatric patients were admitted during the study period, there were 1635 (36.9%) men and 3859 (87.2%) were White with an average age of 81 ± 8.5 years. The mean ISS was 6.7 ± 5.4 and average length of stay was 6 ± 6.3 days. There were 165 deaths. Male gender (OR 1.94, 95% CI 1.38 to 2.73), ISS (OR 1.12, 95% CI 1.09 to 1.14), Emergency Department SBP less than 90 mmHg (OR 6.17, 95% CI 3.17 to 12.01), and having more than one co-morbidity (OR 2.28, 95% CI 1.55 to 3.35) were independently predictive of death on multivariable logistic regression analysis. Conclusion: Male gender, Emergency Department systolic blood pressure less than 90 mmHg, having more than one co-morbidity, and injury severity are independent predictors of mortality among geriatric trauma patients.

Are home environment injuries more fatal in children and the elderly?

INTRODUCTION

'In-home injuries' are those that occur within the house or its immediate surroundings. The literature on the prevalence and magnitude of home injuries is sparse. This study was designed to characterize the mechanisms of 'in-home' injuries and compare their outcomes with 'outside home injuries'.

MATERIALS AND METHODS

The Australia-India Trauma Systems Collaboration (AITSC) Project created a multicentric registry consisting of trauma patients admitted at four urban tertiary care hospitals in India from April 2016 to March 2018. This registry data was analysed for this study. All admitted patients except for dead on arrival were included. Patients were categorised into 'in-home' and 'outside home' cohorts based on the place where the trauma occurred. The outcome measures were 30 day in-hospital mortality and the length of hospital stay. Two subgroup analyses were performed, the first comprised pediatric patients (<15 years) and the second elderly patients >64 years).

RESULTS

Among 9354 patients in the AITSC data registry, 8398 patients were included in the study. Out of these, 29 percent were in-home injuries, whereas the rest occurred outside home. The 30 day in-hospital mortality was 10.6 percent in the 'in-home' cohort, as compared to 13.7 percent in the 'outside home' cohort. This difference although significant on univariable analysis (p <0.01), there was no significant difference on multivariable regression analysis, after adjusting for age and injury severity score (OR = 0.88, 95% CI = 0.73-1.04; p = 0.15). The length of hospital stay was shorter in the home injuries group (median = 5 days; IQR = 3-12 days) compared to the outside-home group (median = 7 days; IQR = 4-14 days) (p < 0.01). In the pediatric and the elderly, on multivariable regression analysis, in-home injuries were associated with higher mortality than outside home injuries.

CONCLUSION

There was no significant difference in the 30 day in-hospital mortality amongst admitted trauma patients sustaining injuries at home or outside the home. However, in pediatric and elderly patients the chances of mortality was significantly higher when injured at home.

Ground Level Falls in Patients Over 60, Do Race and Socioeconomic Status Affect Outcome?

Background

Falls are a significant source of morbidity, mortality, and health care spending in the elderly. The objective was to identify whether race, insurance status, and median income by zip code were associated with discharge disposition, readmission within 90 days, or mortality within 1 year of ground-level falls in patients aged 60-90.

Materials and Methods

We conducted a retrospective chart review of 926 patients aged 60-90 treated for ground-level falls. We created a binomial linear regression model to identify predictors of discharge disposition, 90-day readmission, and mortality within 1 year of discharge.

Results

Length of stay (P < .01), having orthopedic surgery (P < .01), score on Charlson Comorbidity Index (CCI) (P < .01), increasing age (P = .014), female sex (P = .05), and admission to the ICU (P = .05) were associated with discharge to a secondary facility. Readmission within 90 days was only associated with higher scores on the CCI (P < .01). Charlson Comorbidity Index (P < .0001), hospital length of stay (P < .001), and admission to the ICU (P = .015) were associated with increased mortality at 1 year.

Discussion

Predictors of discharge to another facility included hospital length of stay, having orthopedic surgery, CCI scores, increasing age, female sex, and admission to the ICU. Charlson Comorbidity Index score was the only significant predictor of readmission. Predictors of mortality at 1-year post-fall included CCI score, hospital length of stay, and admission to the ICU. Race, median income by zip code, and insurance provider were not statistically significant.

Increased injury severity and hospitalization rates following crashes with e-bikes versus conventional bicycles: an observational cohort study from a regional level II trauma center in Switzerland

Background

As electric bicycles (e-bikes) become increasingly popular, reports of injuries associated with e-bike usage are also rising. Patterns, characteristics, and severity of injuries following e-bike crashes need further investigation, particularly in contrast to injuries from conventional bicycle crashes.

Methods

This prospective observational study included 82 patients treated at a Level II trauma center for injuries resulting from an electric or conventional bicycle crash. Data were collected over one year (05.09.2017–19.09.2018) during in- and outpatient visits. A study-specific case report form was used to identify the bicycle type, cycling behavior (e.g., use of a helmet, safety gear, alcohol), and circumstances of the crash (e.g., road conditions, speed, cause of the incident, time of day, season). Additional information about patient demographics, treatment, and injury characteristics, such as the Injury Severity Score (ISS) and body region injured, were documented. Results were analyzed using chi-square, Fisher’s exact, or Wilcoxon tests. Simple logistic or linear regression models were used to estimate associations.

Results

Of the 82 patients, 56 (67%) were riding a conventional bike and 27 (33%) were using an e-bike. Most incidents were either single-bicycle crashes (66%) or automobile collisions (26%), with no notable difference in prevalence rates between groups. Although a higher proportion of conventional bikers were male (67% vs. 48%), the difference was not significant. E-bikers were older (median 60 years (IQR 44–70) vs. 45 years (IQR 32–62); p = 0.008), were hospitalized more often (48% vs. 24%, p = 0.025), and had worse ISS (median 3 (IQR 2–4) vs. 1 (IQR 1–3), p < 0.001), respectively. Body regions most affected were the extremities (78%) and external/skin (46%), and these were distributed similarly in both groups. Concomitant injury patterns of the thorax/chest with external/skin were higher among e-bikers (p < 0.001). When we controlled for the difference in the median age of the two groups, only the injury severity score of e-bikers remained significantly worse.

Conclusions

Hospitalization and chest trauma rates were higher among e-bikers. After controlling for the older age of this group, the severity of their injuries remained worse than in conventional cyclists. Initial clinical assessments at trauma units should include an evaluation of the thorax/chest, particularly among elderly e-bikers.

Level of evidence

Level III.

Geriatric Trauma in a High-Volume Trauma Centre in Cape Town: How Do We Compare?

BACKGROUND

Little is known about the injury profile of older persons from low-and-middle-income countries, such as South Africa, where violence is prevalent. This study aimed to identify common mechanisms of injury (MOI), severity, complications, and outcomes in elderly patients admitted to a referral trauma centre in Cape Town.

METHODS

A retrospective review was performed of all patients ≥60 years presenting at Tygerberg hospital trauma centre over an eight-month period. Descriptive statistics were computed for all variables of interest, and the relationship between the MOI, injury severity score (ISS), complications, and outcomes were assessed.

RESULTS

Of the total 7,635 trauma cases admitted, patients ≥60 years accounted for 4% (n = 275). The most frequent MOI was low falls (58%). Of these 11% of injuries were intentionally inflicted. Among them 35% of the patients experienced complications. The ISS was positively associated with the number of complications (p < 0.01). The mortality rate was 6.5%. An ISS of ≥10 was associated with increased mortality (p < 0.01). The number of complications was positively associated with mortality (p < 0.01).

CONCLUSIONS

In contrast to high-income countries (HICs), the cohort of elderly patients admitted to the trauma centre made up a relatively small portion of the total admissions. Compared to HICs, intentionally inflicted injuries and preventable MOI were common in our sample, underscoring the importance of addressing causative factors. Notably, the ISS was strongly associated with the number of complications and an ISS ≥10 was associated with mortality, highlighting the utility of the ISS in identifying elderly trauma patients most at risk of negative outcomes.

Effects of Shopping Rehabilitation on Older People's Daily Activities

In an aged society, the deterioration of physical and cognitive functions is prevalent. To motivate the rehabilitation of older persons, an initiative known as “shopping rehabilitation” incorporates shopping as an element of a nudge. The purpose of this study was to clarify motor function changes and cognitive functions of participants during shopping rehabilitation, through a semi-experimental study. We measured changes in the Kihon Checklist score before and after rehabilitation interventions. A paired t-test was used to analyze changes in the overall score of the basic checklist before and after the rehabilitation intervention. In December 2020, 59 participants answered the Kihon Checklist after their shopping rehabilitation intervention. During the 6-month intervention period, the number of participants with a checklist score of 8 or higher was significantly reduced after the intervention (p = 0.050). In the sub-analysis, the score improved significantly for the group with families (p = 0.050). Improvement was observed in the group living alone, but the difference was not significant (p = 0.428). The shopping rehabilitation intervention improved the Kihon Checklist score. Continuous observations and research are necessary to measure the long-term effects of shopping rehabilitation and the mechanisms that foster their maintenance and effects.

Influencing Factors and Prevention of Sepsis or Acute Kidney Injury in 85 Patients with Severe Trauma

Severe trauma can cause systemic reactions, leading to massive bleeding, shock, asphyxia, and disturbance of consciousness. At the same time, patients with severe trauma are at high risk of sepsis and acute renal injury. The occurrence of complications will increase the difficulty of clinical treatment, improve the mortality rate, and bring heavy physical and mental burdens and economic pressure to patients and their families. It is of great clinical significance to understand the high risk factors of sepsis and AKI and actively formulate prevention and treatment measures. In this study, the clinical data of 85 patients with severe trauma were analyzed by univariate and multivariate logistic regression to identify the risk factors leading to sepsis or AKI and analyze the prevention and treatment strategies. The results showed that multiple injuries, APACHE II score on admission, SOFA score on admission, and mechanical ventilation were independent influencing factors of sepsis in patients with severe trauma, while hemorrhagic shock, APACHE II score on admission, CRRT, and sepsis were independent influencing factors of AKI in patients with severe trauma. Severe trauma patients complicated with sepsis or AKI will increase the risk of death. In the course of treatment, prevention and intervention should be given as far as possible to reduce the incidence of complications.

A biomimetic shock model on the effect of endothelial aging on vascular barrier properties

BACKGROUND

Aging is characterized by a decline in cellular function, which has an adverse effect on the biologic response to injury. Both aging and trauma/hemorrhagic shock (T/HS) increase oxidative stress which impairs the vascular endothelium (EC) and glycocalyx (EG). The additive effect of aging on EC and EG damage following T/HS are unknown. This was studied in an in vitro model.

METHODS

Confluent endothelial cell monolayers from primary aortic endothelial cells from 10-week-old mice ("young" cells) or primary aortic cells from 65-week-old mice ("aged" cells) were established in microfluidic devices (MFDs) and perfused at constant shear conditions overnight. Mouse endothelial cell monolayers were then exposed to hypoxia/reoxygenation alone and/or epinephrine or norepinephrine. Endothelial glycocalyx degradation was indexed as well as subsequent endothelial injury/activation.

RESULTS

Aged endothelial cells showed increase glycocalyx shedding and subsequent loss of glycocalyx thickness. This lead to a more pronounced level of EC injury/activation compared with young endothelial cells. Although exposure to biomimetic shock conditions exacerbated both endothelial glycocalyx shedding and endothelial injury in both aged and young endothelial cells, the effect was significantly more pronounced in aged cells.

CONCLUSION

Advanced age is associated with worse outcomes in severely injured trauma patients. Our study demonstrates that there is increased EG shedding and a diminished EG layer in aged compared to "young" endothelial cell layers. Biomimetic shock conditions lead to an even greater impairment of the endothelial glycocalyx in aged versus young endothelial cell monolayers. It appears that these effects are a consequence of aging related oxidative stress at both baseline and shock conditions. This exacerbates shock-induced endotheliopathy and may contribute to untoward effects on patient outcomes in this population.

Pattern of trauma in elderly patients seen at the trauma centre of national hospital Abuja, Nigeria

Introduction

The global population is aging, creating challenges for health systems. The mean age of patients with major trauma has increased over time, posing some challenges for trauma system designs. Elderly trauma patients are said to have higher mortality rates and longer hospital and intensive care unit stays. This study is aimed at assessing the pattern of injuries in elderly population in a dedicated trauma centre of a developing economy.

Methods

This is a retrospective study of all patients aged 60 years and above seen in the trauma centre of a West African tertiary hospital over a three year period from January 2017 to December 2019. Relevant parameters including Sociodemographic data, injury pattern and injury scores were derived from the trauma registry. Data analysis was done using statistical package for social sciences (SPSS) version 24. Results were presented using tables and a figure.

Results

A total of 183 patients aged 60 years and above were enrolled out of 4549 general trauma patients, representing 4% of the trauma patient population seen. Male to female ratio was 2.3 with the mean age of 65 ± 6.3. The most frequent mechanisms of injury were motor vehicular crash (MVC) (48.4%), followed by falls (16.5%). More proportion of females (21.8%) were significantly found to suffer falls compared to their males (14.2%) counterparts (p < 0.05). Traumatic brain injury was the commonest diagnosis accounting for 24.3% of cases. The predominant revised trauma scores (RTS) and injury severity scores (ISS) were 12 and 1–15 respectively, with overall mortality of 6.1%.

Conclusion

The proportion of elderly trauma patients studied in this centre is low. MVC is still the leading mechanism of injury in our elderly trauma population. The mortality rate is however low in this study, in line with the low trauma and severity scores. Preventive measures for MVC should be strongly encouraged to reduce the incidence of elderly trauma patients in this part of the world.

Major Trauma in Elderly Patients: Worse Mortality and Outcomes in an Italian Trauma Center

Introduction:

Major trauma is the leading cause of mortality in the world in patients younger than 40 years. However, the proportion of elderly people who suffer trauma has increased significantly. The purpose of this study is to assess the correlation of old age with mortality and other unfavorable outcomes.

Methods:

We assessed on one hand, anatomical criteria such as ISS values and the number of body regions affected, on the other hand, hemodynamic instability criteria, various shock indices, and Glasgow Coma Scale. Finally, we also evaluated biochemical parameters, such as lactate, BE, and pH values. We conducted a prospective and monocentric observational study of all the patients referred to the Emergency Department of the IRCCS Fondazione Policlinico S. Matteo in Pavia for major trauma in 13 consecutive months: January 1, 2018–January 30, 2019. We compared the elderly population (>75 years) and the younger population (≤75).

Results:

We included 501 patients, among which 10% were over the age of 75 years. The mortality rate was higher among the older patients than among the younger (4% vs. 1.33%; P = 0.050). Hemodynamic instability was more common in the older patients than in the younger (26% vs. 9%; P < 0.001). More older patients (44%) had an ISS >16, in comparison with 32% of younger patients (P = 0.01).

Conclusions:

The elderly showed worse outcomes in terms of mortality, hospitalization rate, hemodynamic instability criteria, and anatomical and biochemical parameters.

Psychological Responses According to Gender during the Early Stage of COVID-19 in Spain

BACKGROUND

Current research has pointed out an increased risk of mental health problems during the COVID-19 pandemic in women compared to men, however the reason for this difference remains unclear. The aim of this research is to study early psychological responses to the pandemic in the Spanish general population, focusing on gender differences.

METHODS

Nine to 14 days after the declaration of a state of emergency an online survey was conducted assessing sociodemographic, health, behavioral and COVID-19-related variables. Mental health status was evaluated by the Depression, Anxiety and Stress Scale (DASS-21), the Impact of Event Scale-Revised (IES-R), and the Self-Care Scale (SCS).

RESULTS

The study included 3520 respondents: 2611 women and 909 men. Women scored significantly higher in DASS-21 and IES-R (p < 0.05) and were more likely to somatize, suffer from hypochondriasis, sleeping disturbances and claustrophobia (p < 0.05). Being a woman can be considered a risk factor for intrusive thoughts, avoidance mechanisms, stress and anxiety (Odd Ratio = 2.7/2.3/2.3/1.6). The risk of presenting posttraumatic symptoms and emotional distress was greater in women (Odd Ratio = 6.77/4.59). General linear models to predict IES-R and DASS-21 scores clarified which variables were gender specific, such as main concerns.

CONCLUSIONS

This study provides evidence that at early stages of the pandemic, women mental health was more impacted and that both genders show different concerns. Gender perspective in secondary and tertiary prevention strategies must be taken into account when facing the distress associated with the pandemic.

Are There Any Red Flag Injuries in Severely Injured Patients in Older Age?

Introduction: Severely injured elderly patients pose a significant burden to trauma centers and, compared with younger patients, have worse prognoses and higher mortality rates after major trauma. The objective of this study was to identify the etiological mechanisms that are associated with severe trauma in elderly patients and to detect which injuries correlate with high mortality in elderly patients. Methods: Using a prospect cohort study model over an 11-year period, severely injured patients (ISS ≥ 16) were divided into two age groups (Group 1: 18–64; Group 2: 65–99 years). A comparison of the groups was conducted regarding injury frequency, trauma mechanism, distribution of affected body parts (AIS and ISS regions) and injury related mortality. Results: In total, 1008 patient were included (Group 1: n = 771; Group 2: n = 237). The most relevant injury in elderly patients was falling from low heights (<3 m) in contrast to traffic accident in young patients. Severely injured patients in the older age group showed a significantly higher overall mortality rate compared to the younger group (37.6% vs. 11.7%; p = 0.000). In both groups, the 30-day survival for patients without head injuries was significantly better compared to patients with head injuries (92.7% vs. 85.3%; p = 0.017), especially analyzing elderly patients (86.6% vs. 58.6%; p = 0.003). The relative risk of 30-day mortality in patients who suffered a head injury was also higher in the elderly group (OR: Group 1: 4.905; Group 2: 7.132). Conclusion: In contrast to younger patients, falls from low heights (<3 m) are significant risk factors for severe injuries in the geriatric collective. Additionally, elderly patients with an ISS ≥ 16 had a significantly higher mortality rate compared to severe injured younger patients. Head injuries, even minor head traumata, are associated with a significant increase in mortality. These findings will contribute to the development of more age-related therapy strategies in severely injured patients.