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Kregel HR, Hatton GE, Harvin JA, Puzio TJ, Wade CE, Kao LS. Identifying Age-Specific Risk Factors for Poor Outcomes After Trauma With Machine Learning. J Surg Res 2024; 296:465-471. [PMID: 38320366 DOI: 10.1016/j.jss.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Risk stratification for poor outcomes is not currently age-specific. Risk stratification of older patients based on observational cohorts primarily composed of young patients may result in suboptimal clinical care and inaccurate quality benchmarking. We assessed two hypotheses. First, we hypothesized that risk factors for poor outcomes after trauma are age-dependent and, second, that the relative importance of various risk factors are also age-dependent. METHODS A cohort study of severely injured adult trauma patients admitted to the intensive care unit 2014-2018 was performed using trauma registry data. Random forest algorithms predicting poor outcomes (death or complication) were built and validated using three cohorts: (1) patients of all ages, (2) younger patients, and (3) older patients. Older patients were defined as aged 55 y or more to maintain consistency with prior trauma literature. Complications assessed included acute renal failure, acute respiratory distress syndrome, cardiac arrest, unplanned intubation, unplanned intensive care unit admission, and unplanned return to the operating room, as defined by the trauma quality improvement program. Mean decrease in model accuracy (MDA), if each variable was removed and scaled to a Z-score, was calculated. MDA change ≥4 standard deviations between age cohorts was considered significant. RESULTS Of 5489 patients, 25% were older. Poor outcomes occurred in 12% of younger and 33% of older patients. Head injury was the most important predictor of poor outcome in all cohorts. In the full cohort, age was the most important predictor of poor outcomes after head injury. Within age cohorts, the most important predictors of poor outcomes, after head injury, were surgery requirement in younger patients and arrival Glasgow Coma Scale in older patients. Compared to younger patients, head injury and arrival Glasgow Coma Scale had the greatest increase in importance for older patients, while systolic blood pressure had the greatest decrease in importance. CONCLUSIONS Supervised machine learning identified differences in risk factors and their relative associations with poor outcomes based on age. Age-specific models may improve hospital benchmarking and identify quality improvement targets for older trauma patients.
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Affiliation(s)
- Heather R Kregel
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas.
| | - Gabrielle E Hatton
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
| | - John A Harvin
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
| | - Thaddeus J Puzio
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas
| | - Charles E Wade
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
| | - Lillian S Kao
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
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Mohd Mokhtar MA, Azhar ZI, Jamaluddin SF, Cone DC, Shin SD, Shaun GE, Chiang WC, Kajino K, Song KJ, Son DN, Norzan NA. Analysis of Trauma Characteristics Between the Older and Younger Adult Patient from the Pan Asian Trauma Outcome Study Registry (PATOS). PREHOSP EMERG CARE 2023; 27:875-885. [PMID: 37459651 DOI: 10.1080/10903127.2023.2237107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Asia is experiencing a demographic shift toward an aging population at an unrivaled rate. This can influence the characteristics and outcomes of trauma. We aim to examine different characteristics of older adult trauma patients compared to younger adult trauma patients and describe factors that affect the outcomes in Asian countries. METHODS This is a retrospective, international, multicenter study of trauma across participating centers in the Pan Asian Trauma Outcome Study (PATOS) registry, which included trauma cases aged ≥18 years, brought to the emergency department (ED) by emergency medical services (EMS) from October 2015 to November 2018. Data of older adults (≥65 years) and younger adults (<65 years) were analyzed and compared. The primary outcome measure was in-hospital mortality, and secondary outcomes were disability at discharge and hospital and intensive care unit (ICU) length of stays. RESULTS Of 39,804 trauma patients, 10,770 (27.1%) were older adults. Trauma occurred more among older adult women (54.7% vs 33.2%, p < 0.001). Falls were more frequent in older adults (66.3% vs 24.9%, p < 0.001) who also had higher mean Injury Severity Score (ISS) compared to the younger adult trauma patient (5.4 ± 6.78 vs 4.76 ± 8.60, p < 0.001). Older adult trauma patients had a greater incidence of poor Glasgow Outcome Scale (GOS) (13.4% vs 4.1%, p < 0.001), higher hospital mortality (1.5% vs 0.9%, p < 0.001) and longer median hospital length of stay (12.8 vs 9.8, p < 0.001). Multiple logistic regression revealed age (adjusted odds ratio [AOR] 1.06, 95%CI 1.02-1.04, p < 0.001), male sex (AOR 1.60, 95%CI 1.04-2.46, p = 0.032), head and face injuries (AOR 3.25, 95%CI 2.06-5.11, p < 0.001), abdominal and pelvic injuries (AOR 2.78, 95%CI 1.48-5.23, p = 0.002), cardiovascular (AOR 2.71, 95%CI 1.40-5.22, p = 0.003), pulmonary (AOR 3.13, 95%CI 1.30-7.53, p = 0.011) and cancer (AOR 2.03, 95%CI 1.02-4.06, p = 0.045) comorbidities, severe ISS (AOR 2.06, 95%CI 1.23-3.45, p = 0.006), and Glasgow Coma Scale (GCS) ≤8 (AOR 12.50, 95%CI 6.95-22.48, p < 0.001) were significant predictors of hospital mortality. CONCLUSIONS Older trauma patients in the Asian region have a higher mortality rate than their younger counterparts, with many significant predictors. These findings illustrate the different characteristics of older trauma patients and their potential to influence the outcome. Preventive measures for elderly trauma should be targeted based on these factors.
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Affiliation(s)
- Mohd Amin Mohd Mokhtar
- Faculty of Medicine, Universiti Teknologi MARA, UiTM Sungai Buloh Campus, Sungai Buloh, Malaysia
| | - Zahir Izuan Azhar
- Faculty of Medicine, Universiti Teknologi MARA, UiTM Sungai Buloh Campus, Sungai Buloh, Malaysia
| | | | | | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Goh E Shaun
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Wen Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Yunlin Branch, National Taiwan University Hospital, Douliu City, Taiwan
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Japan
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Do Ngoc Son
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
| | - Nurul Azlean Norzan
- Emergency and Trauma Department, Sungai Buloh Hospital, Sungai Buloh, Malaysia
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Conn LG, Nathens AB, Scales DC, Vogt K, Wong CL, Haas B. A qualitative study of older adult trauma survivors' experiences in acute care and early recovery. CMAJ Open 2023; 11:E323-E328. [PMID: 37041014 PMCID: PMC10095264 DOI: 10.9778/cmajo.20220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Older adults (aged ≥ 65 yr) account for a substantial proportion of hospital admissions for severe injury, yet little is known about their care experiences and views regarding outcomes. We sought to characterize the acute care and early recovery experiences of older adults who had been discharged after traumatic injury, with a long-term goal to inform the selection of patient-centred process and outcome measures in geriatric trauma. METHODS From June 2018 to September 2019, we conducted telephone interviews with adults aged 65 years or older who had been discharged after traumatic injury within 6 months from Sunnybrook or London Health Sciences Centres in Ontario, Canada. Using interpretive description and thematic analysis, we drew on social science theories of illness and aging for data interpretation. We analyzed data to the point of theoretical saturation. RESULTS We interviewed 25 trauma survivors aged 65-88 years. Most were injured in a fall. Four themes characterized participants' experiences, as follows: "I don't feel like a senior" (i.e., participants disliked being viewed as a senior or as needing senior-specific care); "don't bother telling him anything" (i.e., participants perceived ageist assumptions and treatment in acute care processes); getting back to normal (i.e., participants emphasized their active lifestyles and functional recovery as goals of care); "I have lost control of my life" (i.e., substantial social and personal losses linked to participants' experiences and adaptations to aging generally). INTERPRETATION Findings suggest that older adults experience social and personal loss after injury, and underscore how implicit age bias may influence care experiences and outcomes. This can inform improvements in injury care and guide providers in the selection of patient-centred outcome measures.
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Affiliation(s)
- Lesley Gotlib Conn
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont.
| | - Avery B Nathens
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont
| | - Damon C Scales
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont
| | - Kelly Vogt
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont
| | - Camilla L Wong
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont
| | - Barbara Haas
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont
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Rosenblatt TR, Vail D, Ludwig CA, Al-Moujahed A, Pasricha MV, Ji MH, Callaway NF, Moshfeghi DM. Fall risk in patients with pseudophakic monovision. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:11-17. [PMID: 34419423 DOI: 10.1016/j.jcjo.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/12/2021] [Accepted: 07/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Vision changes can precipitate falls in the elderly resulting in significant morbidity and mortality. We hypothesized that pseudophakic monovision and ensuing anisometropia and aniseikonia impact elderly fall risk. This study assessed fall risk in patients with pseudophakic monovision, pseudophakic single vision distance (classic cataract surgery), and cataracts with no surgery. DESIGN Retrospective single-institution cohort study PARTICIPANTS: Patients with bilateral cataracts diagnosed at 60 years of age or older who underwent bilateral cataract surgery (monovision or single vision distance) or did not undergo any cataract surgery (n = 13 385). Patients with unilateral surgery or a fall prior to cataract diagnosis were excluded. METHODS Data were obtained from the Stanford Research Repository. Time-to-fall analysis was performed across all 3 groups. Primary outcome was hazard ratio (HR) for fall after second eye cataract surgery or after bilateral cataract diagnosis. RESULTS Of 13 385 patients (241 pseudophakic monovision, 2809 pseudophakic single vision, 10 335 no surgery), 850 fell after cataract diagnosis. Pseudophakic monovision was not associated with fall risk after controlling for age, sex, and myopia. Pseudophakic single-vision patients had a decreased time to fall compared with no-surgery patients (log rank, p < 0.001). Older age at cataract diagnosis (HR =1.05, 95% confidence interval [CI] 1.04-1.06, p < 0.001) or at time of surgery (HR = 1.05, 95% CI 1.03-1.07, p < 0.001) increased fall risk, as did female sex (HR = 1.29, 95% CI 1.10-1.51, p = 0.002) and preexisting myopia (HR = 1.31, 95% CI 1.01-1.71, p = 0.046) among nonsurgical patients. CONCLUSIONS Pseudophakic monovision did not impact fall risk, but pseudophakic single vision may increase falls compared with patients without cataract surgery.
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Affiliation(s)
- Tatiana R Rosenblatt
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA.
| | - Daniel Vail
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
| | - Cassie A Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Ahmad Al-Moujahed
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
| | | | - Marco H Ji
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalia F Callaway
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
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Maurer E, Wallmeier V, Reumann M, Ehnert S, Ihle C, Schreiner AJ, Flesch I, Stollhof LE, Histing T, Nüssler AK. Erhöhtes Alter, kardiovaskuläre Nebenerkrankungen, COPD und Diabetes mellitus bedingen eine Übersterblichkeit in der septischen Unfallchirurgie. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022. [PMID: 35158393 DOI: 10.1055/a-1659-4823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Hintergrund Die konstante Überalterung der Bevölkerung in Deutschland führt u.a. zu einer Zunahme des durchschnittlichen Alters hospitalisierter Patienten. Hiermit einher gehen eine
reduzierte physiologische Reserve und ein reduzierter körpereigener Abwehrmechanismus und folglich eine gesteigerte Infekt- und Komplikationsanfälligkeit. Die Altersentwicklung der
septischen Unfallchirurgie ist im Vergleich zur Unfallchirurgie wenig erforscht. Zudem ist der Einfluss des Alters, verschiedener Vorerkrankungen, aber auch der des Alkohol- und
Nikotinkonsums auf die Mortalität in der septischen Unfallchirurgie unzureichend untersucht.
Methode 2014/15 (Exam1) wurden 345 Patienten der septischen Unfallchirurgie in die Studie eingeschlossen. 2017/18 (Exam2) erfolgte das 3-Jahres-Follow-up. Die Befragungen (Exam1 und
2) umfassten demografische Parameter, Nebenerkrankungen, die Medikamenteneinnahme, Alkohol- und Nikotinkonsum sowie verschiedene Parameter zur Morbidität. Hieraus wurde das Sterberisiko in
der septischen Unfallchirurgie in Abhängigkeit von den verschiedenen Risikofaktoren (Alter, Nebenerkrankungen, Medikamenteneinnahme und Noxen) berechnet. Zudem wurde die Entwicklung des
Patientenalters in der Unfallchirurgie sowie speziell in der septischen Unfallchirurgie zwischen 2010 und 2019 ausgewertet.
Ergebnisse 2014/15 (Exam1) wurden 345 Patienten in die Studie eingeschlossen. Hiervon konnten 2017/18 274 (79,4%) telefonisch erreicht werden. 36 (10,4%) lehnten eine Nachbefragung
ab. 20 (8,4%) der 238 verbleibenden Probanden waren bereits verstorben, 218 (63,2%) nahmen erneut teil. Zwischen 2010 (n = 492) und 2019 (n = 885) nahm die Patientenzahl der septischen
Unfallchirurgie in unserer Abteilung um 79,9% zu, wobei besonders der Anteil der unter 65-Jährigen anstieg. Ab dem 60. Lebensjahr stieg die Sterbewahrscheinlichkeit (60. Lj: 0,0377 vs. 70.
Lj: 0,1395) sprunghaft an; wobei in der septischen Unfallchirurgie die eines 60-Jährigen der Sterbewahrscheinlichkeit eines 80-Jährigen der Normalbevölkerung entsprach. Nikotin- (p = 0,93)
und Alkoholkonsum (p = 0,344) zeigten keinen signifikanten Einfluss auf die Sterblichkeit, während kardiale Vorerkrankungen (p = 0,01), die COPD (p = 0,01), der Diabetes mellitus (p = 0,05)
und die pAVK (p = 0,01) mit einer signifikant erhöhten Sterblichkeit einhergingen.
Schlussfolgerung Das Alter, kardiale Vorerkrankungen, aber auch die COPD, der Diabetes mellitus und die periphere arterielle Verschlusskrankheit gehen mit einer signifikant erhöhten
Sterblichkeit in der septischen Unfallchirurgie einher. Eine exponentielle Zunahme des Sterblichkeitsrisikos besteht zwischen dem 50. und 60. Lebensjahr, wobei das Risiko zu versterben eines
60-jährigen Patienten der septischen Unfallchirurgie dem eines 80-jährigen aus der Normalbevölkerung entspricht.
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Affiliation(s)
- Elke Maurer
- Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Vera Wallmeier
- Klinik für Hals-Nasen-Ohrenkrankheiten, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Deutschland
| | - Marie Reumann
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Deutschland
| | - Sabrina Ehnert
- Klinik für Unfall- und Wiederherstellungschirurgie, Eberhardt Karls Universität Tübingen, Tübingen, Deutschland
| | - Christoph Ihle
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Deutschland
| | - Anna J Schreiner
- Klinik für Unfall- und Wiederherstellungschirurgie, BG-Unfallklinik Tübingen, Tübingen, Deutschland
| | - Ingo Flesch
- Sektion für septische und Fußchirurgie, BG Unfallklinik Tübingen, Tübingen, Deutschland
| | - Laura Emine Stollhof
- Klinik für Orthopädie und Unfallchirurgie, Stauferklinikum Mutlangen, Mutlangen, Deutschland
| | - Tina Histing
- Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Andreas K Nüssler
- Siegfried-Weller-Institut für unfallmedizinische Forschung, Eberhard-Karls-Universität Tübingen, BG Unfallklinik Tübingen, Tübingen, Deutschland
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Walsh K, O'Keeffe F, Brent L, Mitra B. Tranexamic acid for major trauma patients in Ireland. World J Emerg Med 2022; 13:11-17. [PMID: 35003409 DOI: 10.5847/wjem.j.1920-8642.2022.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2 (CRASH-2) is the largest randomized control trial (RCT) examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid (TXA) within 3 hours of injury. Since the publication of CRASH-2, significant geographical variance in the use of TXA for trauma patients exists. This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2. METHODS A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network (TARN). All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation (as defined by systolic blood pressure [SBP] <100 mmHg [1 mmHg=0.133 kPa] and administration of blood products) were eligible for inclusion. Death at hospital discharge was the primary outcome. RESULTS During the study period, a total of 234 patients met the inclusion criteria. Among injured patients presenting with hemorrhagic shock, 133 (56.8%; 95% confidence interval [CI] 50.2%-63.3%) received TXA. Of patients that received TXA, a higher proportion of patients presented with shock index >1 (70.68% vs.57.43%) and higher Injury Severity Score (ISS >25; 49.62% vs. 23.76%). Administration of TXA was not associated with mortality at hospital discharge (odds ratio [OR] 0.86, 95% CI 0.31-2.38). CONCLUSIONS Among injured Irish patients presenting with hemorrhagic shock, TXA was administered to 56.8% of patients. Patients administered with TXA were on average more severely injured. However, a mortality benefit could not be demonstrated.
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Affiliation(s)
- Kieran Walsh
- National Trauma Research Institute, the Alfred Hospital, Melbourne 3004, Australia.,Critical Care Research, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia.,Emergency & Trauma Centre, Alfred Health, Melbourne 3004, Australia
| | - Francis O'Keeffe
- National Trauma Research Institute, the Alfred Hospital, Melbourne 3004, Australia.,Emergency Department, Mater Misericordiae University Hospital, Dublin D07 R2WY, Ireland
| | - Louise Brent
- National Office for Clinical Audit, Ardilaun House, Dublin D02 VN51, Ireland
| | - Biswadev Mitra
- National Trauma Research Institute, the Alfred Hospital, Melbourne 3004, Australia.,Critical Care Research, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia.,Emergency & Trauma Centre, Alfred Health, Melbourne 3004, Australia
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Dingley SD, Bauerle WB, Ramirez C, Weber H, Wilde-Onia R, Szoke AM, Benton A, Frutiger D, Mira AE, Hoff W, Stawicki SP. Identification of Seniors at Risk Scoring in Geriatric Trauma: Exploring Clinical Outcome Correlations. J Emerg Trauma Shock 2022; 15:93-98. [PMID: 35910314 PMCID: PMC9336643 DOI: 10.4103/jets.jets_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/16/2022] [Accepted: 04/22/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Geriatric trauma patients (GTP) make up an increasing percentage of the overall trauma population. Due to frailty, GTP are at an increased risk of morbidity and readmission. Therefore, it is becoming increasingly important to prognosticate outcomes to assist with resource utilization. We hypothesized that the "Identification of Seniors at Risk" (ISAR) score may correlate with both clinical outcomes and resource utilization for geriatric trauma patients. Methods Patients older than 65 years who were admitted to the trauma service were screened using an ISAR scoring algorithm. Outcomes, including 30-day mortality, all-cause morbidity, hospital length of stay (LOS), intensive care unit (ICU) LOS, functional independence measures (FIM) at discharge, and percent discharged to a facility, were analyzed. Both descriptive and data-appropriate parametric and non-parametric statistical approaches were utilized, with significance set at α = 0.05. Results One thousand and two hundred seventeen GTP were included in this study. The average age was 81, median injury severity score was 9, and 99% had a blunt trauma mechanism. ISAR scores were generally associated with increasing 30-day mortality (0%, 1.9%, 2.4%, and 2.1% for ISAR 0, ISAR 1-2, ISAR 3-4, and ISAR 5-6, respectively), morbidity (2.6%, 7.6%, 14.7%, and 7.3% for respective categories), longer hospital (3.1, 4.6, 5.1, and 4.3 days, respectively) and ICU stays (0.37, 0.64, 0.81, and 0.67, respectively), lower FIM score at discharge (18.5, 17.1, 15.8, and 14.4, for respective categories), as well as increasing percentage of patients discharged to a facility (29.8%, 58.9%, 72.1%, and 78.8% for respective categories). Conclusions This exploratory study provides important early insight into potential relationships between ISAR and geriatric trauma outcomes. ISAR screening is a quick and easy-to-use tool that may be useful in GTP triage, level-of-care determination, and disposition planning. Understanding populations at risk, especially those with more intricate discharge needs, is an important step in mitigating those risks and implementing appropriate care plans.
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Affiliation(s)
- Stephen D. Dingley
- Department of Surgery, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Wayne B. Bauerle
- Department of Surgery and Research & Innovation, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA,Address for correspondence: Dr. Wayne B. Bauerle, Department of Research and Innovation, 801 Ostrum Street, Bethlehem, PA 18015, USA. E-mail:
| | - Christine Ramirez
- Department of Surgery, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Holly Weber
- Department of Surgery, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Rebecca Wilde-Onia
- Department of Surgery, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Ann-Marie Szoke
- Department of Surgery, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Adam Benton
- Department of Surgery, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Danielle Frutiger
- Department of Surgery, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Alaa-Eldin Mira
- Department of Surgery, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA
| | - William Hoff
- Department of Surgery, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Stanislaw P. Stawicki
- Department of Surgery and Research & Innovation, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA
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8
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Alipour V, Azami-Aghdash S, Rezapour A, Derakhshani N, Ghiasi A, Yusefzadeh N, Taghizade S, Amuzadeh S. Cost-Effectiveness of Multifactorial Interventions in Preventing Falls among Elderly Population: A Systematic Review. Bull Emerg Trauma 2021; 9:159-168. [PMID: 34692866 PMCID: PMC8525694 DOI: 10.30476/beat.2021.84375.1068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 01/25/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022] Open
Abstract
Objective: To review the cost-effectiveness of multifactorial interventions to prevent falls in elderly people. Methods: In this systematic review, the databases including PubMed via MEDLINE, Web of Science, Embase, Scopus, Cochrane Library and Google Scholar (from 1st January 2000 to 30th February) were used. All pre-reviewed articles related to cost-effectiveness analysis of multifactorial interventions to prevent falls in elderly were included in this paper and congresses abstracts were excluded. Descriptive statistics were used for quantitative data and content-analysis method to analyze qualitative data. Results: Out of the 456 articles, 19 were finally included in the study. Eighteen articles were conducted in High-Income Countries (HICs) and 16 were at the community level. Medical visits consultation and education were the most common interventions. Most studies were cost-effectiveness and using the Randomized Control Trial (RCT) methods. A fall of prevention costs ranged from $ 272 to $ 987. Incremental Cost-Effectiveness Ratio (ICER) interventions also ranged from the US $ 120,667 to the US $ 4280.9. Conclusion: The results show that despite the high effectiveness of multifactorial interventions to prevent elderly falls, the cost of the interventions are high and they are not very cost-effective. It would be better to design and implement multifactorial interventions with low cost and high effectiveness that are appropriate for each country.
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Affiliation(s)
- Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Derakhshani
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Akbar Ghiasi
- Health Administration HEB School of Business & Administration, University of the Incarnate Word, Texas, USA
| | - Neghar Yusefzadeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Taghizade
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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9
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Nagassima Rodrigues Dos Reis K, McDonnell JM, Ahern DP, Evans S, Gibbons D, Butler JS. Changing Demographic Trends in spine trauma: The presentation and outcome of Major Spine Trauma in the elderly. Surgeon 2021; 20:e410-e415. [PMID: 34600828 DOI: 10.1016/j.surge.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 11/30/2020] [Accepted: 08/19/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Major trauma has seen a demographic shift in recent years and it is expected that the elderly population will comprise a greater burden on the major trauma service in the near future. However, whether a similar trend exists in those undergoing operative intervention for spinal trauma remains to be elucidated. AIMS To compare the presentation and outcomes of patients ≥65 years of age sustaining spine trauma to those <65 years at a national tertiary referral spine centre. METHODS The local Trauma Audit Research Network (TARN) database was analysed to identify spinal patients referred to our institution, a national tertiary referral centre, between 01/2016 and 05/2019. Patients were divided into a young cohort (16-64 years old) and an elderly cohort (> 64 years old). No explicit distinction was made between major and minor spine trauma cases. Variables analysed included patient demographics, injury severity, mortality, interventions, mechanism of injury and length of hospital stay. RESULTS A total of 669 patients were admitted of which 480 patients underwent operative intervention for spinal trauma. Within the elderly cohort, this represented 75.3% of cases. Among the younger population, road traffic collisions were the most common mechanism of injury (37.1%), while low falls (<2 m) (57.4%) were the most common mechanism among the older population. Patients ≥65 years old had significantly longer length of stay (21 days [1-194] v 14 days [1-183]) and suffered higher 30-day mortality rates (4.6% [0-12] v 0.97% [0-4]). CONCLUSION Orthopaedic spinal trauma in older people is associated with a significantly higher mortality rate as well as a longer duration of hospitalization. Even though severity of injury is similar for both young and old patients, the mechanism of injury for the older population is of typically much lower energy compared to the high energy trauma affecting younger patients.
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Affiliation(s)
| | - Jake M McDonnell
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland.
| | - Daniel P Ahern
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Ireland
| | - Shane Evans
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Denys Gibbons
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
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10
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Huntington CR, Kao AM, Sing RF, Ross SW, Christmas AB, Prasad T, Lincourt AE, Kasten KR, Heniford BT. Unseen Burden of Injury: Post-Hospitalization Mortality in Geriatric Trauma Patients. Am Surg 2021:31348211046886. [PMID: 34555960 DOI: 10.1177/00031348211046886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVES Older adults are at risk for adverse outcomes after trauma, but little is known about post-acute survival as state and national trauma registries collect only inpatient or 30-day outcomes. This study investigates long-term, out-of-hospital mortality in geriatric trauma patients. METHODS Level I Trauma Center registry data were matched to the US Social Security Death Index (SSDI) to determine long-term and out-of-hospital outcomes of older patients. Blunt trauma patients aged ≥65 were identified from 2009 to 2015 in an American College of Surgeons Level 1 Trauma Center registry, n = 6289 patients with an age range 65-105 years, mean age 78.5 ± 8.4 years. Dates of death were queried using social security numbers and unique patient identifiers. Demographics, injury, treatments, and outcomes were compared using descriptive and univariate statistics. RESULTS Of 6289 geriatric trauma patients, 505 (8.0%) died as an inpatient following trauma. Fall was the most common mechanism of injury (n = 4757, 76%) with mortality rate of 46.5% at long-term follow-up; motor vehicle crash (MVC) (n = 1212, 19%) had long-term mortality of 27.6%. Overall, 24.1% of patients died within 1 year of trauma. Only 8 of 488 patients who died between 1 and 6 months post-trauma were inpatient. Mortality rate varied by discharge location: 25.1% home, 36.4% acute rehabilitation, and 51.5% skilled nursing facility, P < .0001. CONCLUSION Inpatient and 30-day mortality rates in national outcome registries fail to fully capture the burden of trauma on older patients. Though 92% of geriatric trauma patients survived to discharge, almost one-quarter had died by 1 year following their injuries.
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Affiliation(s)
- Ciara R Huntington
- Department of Surgery, 2351St. Luke's Regional Medical Center, Boise, Idaho, USA
| | - Angela M Kao
- Division of Gastrointestinal and Minimally Invasive Surgery, 2351Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Ronald F Sing
- 22442Division of Acute Care Surgery, Carolinas Medical Center, Charlotte, USA
| | - Samuel W Ross
- 22442Division of Acute Care Surgery, Carolinas Medical Center, Charlotte, USA
| | - A Britt Christmas
- 22442Division of Acute Care Surgery, Carolinas Medical Center, Charlotte, USA
| | - Tanushree Prasad
- Division of Gastrointestinal and Minimally Invasive Surgery, 2351Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Amy E Lincourt
- Division of Gastrointestinal and Minimally Invasive Surgery, 2351Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Kevin R Kasten
- Division of Gastrointestinal and Minimally Invasive Surgery, 2351Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, 2351Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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11
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Diaz J, Rooney A, Calvo RY, Benham DA, Carr M, Badiee J, Sise CB, Sise MJ, Bansal V, Martin MJ. Isolated Intracranial Hemorrhage in Elderly Patients With Pre-Injury Anticoagulation: Is Full Trauma Team Activation Necessary? J Surg Res 2021; 268:491-497. [PMID: 34438190 DOI: 10.1016/j.jss.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Traumatic intracranial hemorrhage (ICH) is a highly morbid injury, particularly among elderly patients on preinjury anticoagulants (AC). Many trauma centers initiate full trauma team activation (FTTA) for these high-risk patients. We sought to determine if FTTA was superior compared with those who were evaluated as a trauma consultation (CON). METHODS Patients aged ≥55 on preinjury AC who presented from January 2015 to December 2019 with blunt isolated head injury (non-head AIS ≤2) and confirmed ICH were identified. CON patients and FTTA patients were matched by age and head AIS. Cox proportional hazard model was used to assess patient and injury characteristics with mortality and survivor discharge disposition. REASULTS There were 45 CON patients and 45 FTTA patients. Mean age was 80 years in both groups. Fall was the most common mechanism (98% CON vs. 92% FTTA). Glasgow Coma Score (GCS) was lower in FTTA (14 vs. 15, p<0.01). CON had a significantly longer time from arrival to CT scan (1.3 vs. 0.4 hrs, p<0.01). Hospital days were similar (CON: 3.9 vs. FTTA: 3.7 days). However, CON had increased ventilator use (p=0.03). Lower admission GCS was the only factor associated with increased risk of death. Among survivors, only head AIS increased the risk of discharge to a level of care higher than that of preinjury (p=0.01). CONCLUSION There was no difference in mortality or adverse discharge disposition between FTTA and CON, although FTTA was associated with a more rapid evaluation and diagnosis. Any alteration in GCS was strongly associated with mortality and should prompt evaluation by FTTA.
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Affiliation(s)
- Joseph Diaz
- Trauma Service, Scripps Mercy Hospital, San Diego, California
| | | | - Richard Y Calvo
- Trauma Service, Scripps Mercy Hospital, San Diego, California
| | - Derek A Benham
- Trauma Service, Scripps Mercy Hospital, San Diego, California
| | - Matthew Carr
- Trauma Service, Scripps Mercy Hospital, San Diego, California
| | - Jayraan Badiee
- Trauma Service, Scripps Mercy Hospital, San Diego, California
| | - C Beth Sise
- Trauma Service, Scripps Mercy Hospital, San Diego, California
| | - Michael J Sise
- Trauma Service, Scripps Mercy Hospital, San Diego, California
| | - Vishal Bansal
- Trauma Service, Scripps Mercy Hospital, San Diego, California
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12
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Kelly LS, Darden DB, Fenner BP, Efron PA, Mohr AM. The Hematopoietic Stem/Progenitor Cell Response to Hemorrhage, Injury, and Sepsis: A Review of Pathophysiology. Shock 2021; 56:30-41. [PMID: 33234838 PMCID: PMC8141062 DOI: 10.1097/shk.0000000000001699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
ABSTRACT Hematopoietic stem/progenitor cells (HSPC) have both unique and common responses following hemorrhage, injury, and sepsis. HSPCs from different lineages have a distinctive response to these "stress" signals. Inflammation, via the production of inflammatory factors, including cytokines, hormones, and interferons, has been demonstrated to impact the differentiation and function of HSPCs. In response to injury, hemorrhagic shock, and sepsis, cellular phenotypic changes and altered function occur, demonstrating the rapid response and potential adaptability of bone marrow hematopoietic cells. In this review, we summarize the pathophysiology of emergency myelopoiesis and the role of myeloid-derived suppressor cells, impaired erythropoiesis, as well as the mobilization of HSPCs from the bone marrow. Finally, we discuss potential therapeutic options to optimize HSPC function after severe trauma or infection.
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Affiliation(s)
- Lauren S Kelly
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
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13
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Thompson A, Gida S, Nassif Y, Hope C, Brooks A. The impact of frailty on trauma outcomes using the Clinical Frailty Scale. Eur J Trauma Emerg Surg 2021; 48:1271-1276. [PMID: 33682027 PMCID: PMC7937544 DOI: 10.1007/s00068-021-01627-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/21/2021] [Indexed: 12/17/2022]
Abstract
Background Population ageing is a worldwide phenomenon; thanks to improvements in medical care and living standards. The Office of National Statistics in the UK predicts that the fastest growing age group in coming decades will be those over 85 years. This is reflected in Trauma Audit and Research Network data, which has highlighted a shift in caseload from a majority of young males to elderly patients at UK Major Trauma Centres (MTC). This study of elderly trauma patients admitted to a UK MTC reviews the links between frailty, using the Canadian Study of Health and Aging Clinical Frailty Scale (CFS), and outcomes from trauma. Methods A retrospective database review of patients > 65 years old admitted to our MTC was performed. We identified 1125 eligible patients of which 729 had a recorded CFS. Those without a CFS were omitted. The primary outcome measured was in-hospital mortality. Secondary measures were Injury Severity Score, length of stay, trauma team activation on arrival and discharge destination. Multivariate regression analyses were performed using STATA v 15. Results Those of CFS 5–9 (frail) were 2.6 times more likely to die than the CFS 1–4 (pre-frail) (OR 2.65, 95% CI 1.47–4.78). The frail group was also 56% less likely to have a trauma call on admission (OR 0.44, 95% CI 0.30–0.65) and 61% less likely to be discharged to their usual place of residence (OR 0.39, 95% CI 0.28–0.55). Conclusion We advocate the use of the Clinical Frailty Scale as a screening tool for frailty in trauma patients, highlighting those at risk of increased length of stay and mortality, subsequently assisting healthcare providers with setting realistic expectations with family members. Level of evidence Level III, prognostic and epidemiological
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Affiliation(s)
- Amari Thompson
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham, NG7 2UH, England, UK.
| | - Sunil Gida
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham, NG7 2UH, England, UK
| | - Yasar Nassif
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham, NG7 2UH, England, UK
| | - Carla Hope
- Royal Derby Hospital, Derby, England, UK
| | - Adam Brooks
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham, NG7 2UH, England, UK
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14
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Lee IY, Shih CY, Wei YT, Weng TC, Shieh SJ, Wang JD. Increasing burden of major trauma in elderly adults during 2003-2015: Analysis of real-world data from Taiwan. J Formos Med Assoc 2021; 121:144-151. [PMID: 33674232 DOI: 10.1016/j.jfma.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/17/2020] [Accepted: 02/07/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Major trauma has been one of the leading causes of morbidity, mortality, and functional disability, resulting in substantial societal burden. The aim of this study was to estimate the trends in burden of adult major trauma in Taiwan during 2003-2015. METHODS Adult patients with initial encounter of major trauma (injury severity score ≥ 16) were abstracted from the claim data of National Health Insurance (NHI) in Taiwan from January 2003 to December 2015. We explored the trends of incidence and mortality rates over time stratified by age and sex, as well as life expectancy (LE), loss-of-LE, lifetime healthcare expenditure and total loss-of-LE compared with age, sex and calendar-year matched referents simulated from the vital statistics of Taiwan. RESULTS A total of 71,731 cases of adult major trauma, and an estimated loss of 979,676 life-years were found with an increasing trend in cumulative incidence rate (CIR18-84) during 2003-2015. The incidence rates were significantly higher in men than women. For both sexes, the incidence rates for those aged 65 and above were about 2-3 times higher than those of all other age groups. The one-year case fatality rates among the elderly were about 31-61%, higher than all other ages. The lifetime healthcare expenditures per person were 47,616 USD in men and 43,416 USD in women. CONCLUSION There is a consistently increasing trend in incidence and mortality of major trauma in Taiwan, especially among elderly people. For Taiwan, an aged society beginning since 2018, the challenge should be tackled more effectively in the coming decades.
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Affiliation(s)
- I-Ying Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Yin Shih
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ting Wei
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ting-Chia Weng
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shyh-Jou Shieh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan; School of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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15
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Cuevas-Østrem M, Røise O, Wisborg T, Jeppesen E. Epidemiology of geriatric trauma patients in Norway: A nationwide analysis of Norwegian Trauma Registry data, 2015-2018. A retrospective cohort study. Injury 2021; 52:450-459. [PMID: 33243523 DOI: 10.1016/j.injury.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Geriatric patients have a high risk of poor outcomes after trauma and is a rapid-increasing group within the trauma population. Given the need to ensure that the trauma system is targeted, efficient, accessible, safe and responsive to all age groups the aim of the present study was to explore the epidemiology and characteristics of the Norwegian geriatric trauma population and assess differences between age groups within a national trauma system. MATERIALS AND METHODS This retrospective analysis is based on data from the Norwegian Trauma Registry (2015-2018). Injury severity was scaled using the Abbreviated Injury Scale (AIS), and the New Injury Severity Score (NISS). Trauma patients 16 years or older with NISS ≥9 were included, dichotomized into age groups 16-64 years (Group 1, G1) and ≥65 years (Group 2, G2). The groups were compared with respect to differences in demographics, injury characteristics, management and outcome. Descriptive statistics and relevant parametric and non-parametric tests were used. RESULTS Geriatric patients proved to be at risk of sustaining severe injuries. Low-energy falls predominated in G2, and the AIS body regions 'Head' and 'Pelvis and lower extremities' were most frequently injured. Crude 30-day mortality was higher in G2 compared to G1 (G1: 2.9 vs. G2: 13.6%, P<0.01) and the trauma team activation (TTA) rate was lower (G1: 90 vs. G2: 73%, P<0.01). A lower proportion of geriatric patients were treated by a physician prehospitally (G1: 30 vs. G2: 18%, [NISS 15-24], P<0.01) and transported by air-ambulance (G1: 24 vs. G2: 14%, [NISS 15-24], P<0.01). Median time from alarm to hospital admission was longer for geriatric patients (G1: 71 vs. G2: 78 min [NISS 15-24], P<0.01), except for the most severely injured patients (NISS≥25). CONCLUSION In this nationwide study comparing adult and geriatric trauma patients, geriatric patients were found to have a higher mortality, receive less frequently advanced prehospital treatment and transportation, and a lower TTA rate. This is surprising in the setting of a Nordic country with free access to publicly funded emergency services, a nationally implemented trauma system with requirements to pre- and in-hospital services and a national trauma registry with high individual level coverage from all trauma-receiving hospitals. Further exploration and a deeper understanding of these differences is warranted.
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Affiliation(s)
- Mathias Cuevas-Østrem
- Faculty of Health Sciences, University of Stavanger, Norway; Department of Research, Norwegian Air Ambulance Foundation, NO-0103 Oslo, Norway.
| | - Olav Røise
- Faculty of Health Sciences, University of Stavanger, Norway; Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torben Wisborg
- Anesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway
| | - Elisabeth Jeppesen
- Faculty of Health Sciences, University of Stavanger, Norway; Department of Research, Norwegian Air Ambulance Foundation, NO-0103 Oslo, Norway
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Abstract
Fall represents an important cause of death and its relation with the population aging evidences the need of a broad analysis considering different aspects associated with its occurrence. The objective of this study was to compare fatal victims due to unintentional fall among adults, young olds, olds, and oldest olds, according to sociodemographic data, characteristics, and severity of the trauma. This study is a cross-sectional, comparative study analyzing autopsy reports of fatal victims due to fall, admitted to the Medical Legal Institute of Sao Paulo, Sao Paulo, Brazil, in 2015. The following age groups were: adults (≥18 and <60 years), young olds (≥60 and <70 years), olds (≥70 and <80 years), and oldest olds (≥80 years). The Pearson's χ, Fisher's exact, Kruskal-Wallis, and Dunn tests were applied to compare the groups, with a significance level of 5%. Regarding the 469 fatalities analyzed (57.8% males, mean age: 71.3 ± 18.2 years), there was a higher frequency of oldest olds (43.5%), ground-level falls (70.1%), femoral fractures (35.0%), and delayed deaths (79.6%) due to posttraumatic complications (57.2%). Adults, young olds, olds, and oldest olds differed significantly (p ≤ .005) in relation to the total of analyzed variables, with a special remark on the differences between the age extremes. High frequencies of femoral fractures and delayed deaths due to complications of treatment in low-severity fall victims, especially those older than 70 years, make it necessary to improve fall prevention programs in the older adults and to create a line of care for this population.
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17
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Francis AA, Wall JEM, Stone A, Dewane MP, Dyke A, Gregg SC. The Impact of Interdisciplinary Care on Cost Reduction in a Geriatric Trauma Population. J Emerg Trauma Shock 2020; 13:286-295. [PMID: 33897146 PMCID: PMC8047963 DOI: 10.4103/jets.jets_151_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/24/2020] [Accepted: 05/08/2020] [Indexed: 11/16/2022] Open
Abstract
The current growth of the geriatric population and increased burden on trauma services throughout the United States (US) has created a need for systems that can improve patient care and reduce hospital costs. We hypothesize that the multidisciplinary services provided through the Geriatric Injury Institute (GII) can reduce hospital costs, improve patient triage throughput, and decrease hospital length of stay (LOS).
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Affiliation(s)
- Andrew A Francis
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Joyce E M Wall
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Andrew Stone
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Michael P Dewane
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Ann Dyke
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Shea C Gregg
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
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18
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Chiang YT, Lin TH, Hu RH, Lee PC, Shih HC. Predicting factors for major trauma patient mortality analyzed from trauma registry system. Asian J Surg 2020; 44:262-268. [PMID: 32859471 DOI: 10.1016/j.asjsur.2020.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We investigated the predictors of mortality in major trauma patients using a trauma registry system database. METHODS Data were obtained from the trauma registry of a level I trauma center for all patients aged ≥18 years admitted to an intensive care unit (ICU) between January 1, 2006 and December 31, 2013. Models were adjusted for patient demographics, injury mechanism, preexisting comorbidity, Glasgow coma scale (GCS), injury severity score (ISS), emergency department (ED) and ICU procedures, surgical procedures, and complications. Multivariate logistic regression analysis was used to determine predictors of mortality and odds ratios of its associated factors. RESULTS In total, 1561 patients met the inclusion criteria. The overall mortality rate was 13.4%. After controlling for all variables in a logistic regression model, the factors associated with increased mortality risk (P < 0.05) were age ≥ 45 years; ISS > 24; GCS score < 8 and 8-12; fall accident; preexisting comorbidity of renal insufficiency; ED cardiopulmonary resuscitation (CPR) procedures; ICU blood transfusion; and cardiovascular, respiratory, digestive system and infection complications. CONCLUSION Our data showed some predictors of patient mortality after major trauma, most of which were determined during the trauma event. Only those treatment complications may be improved when performing the treatment procedures.
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Affiliation(s)
- Yueh-Tzu Chiang
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taiwan, ROC; Department of Orthopedics, KuangTien General Hospital, Taiwan, ROC.
| | - Tzu-Hsin Lin
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC.
| | - Rey-Heng Hu
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC
| | - Po-Chu Lee
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC
| | - Hsin-Chin Shih
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taiwan, ROC
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Varachhia S, Ramcharitar Maharaj V, Paul JF, Robertson P, Nunes P, Sammy I. Factors affecting mortality in major trauma patients in Trinidad and Tobago – A view from the developing world. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619885505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction There are few data on major trauma in the developing world. This study investigated the characteristics and outcomes of seriously injured patients in Trinidad and Tobago, using Trauma and Injury Severity Score (TRISS) methodology. We also aimed to assess the predictive accuracy of the TRISS model in patients in Trinidad and Tobago. Methods Retrospective data from major trauma patients attending the Emergency Department of a tertiary hospital in Trinidad between 2010 and 2014 were analysed. Patients ≥18 years having an Injury Severity Score >15 were included. The impact of age, gender, comorbidities, mechanisms and patterns of injury on mortality was investigated. Using TRISS methodology, predicted mortality was calculated and compared to actual mortality. Results Of 323 patients analysed, 284 were male and 24 were aged ≥65 years. The commonest injury mechanisms in younger people were motor vehicle accidents (34.1%) and stabbings (30.8%) compared to falls (66.7%) and motor vehicle accidents (20.8%) in people aged ≥65 years. The commonest areas injured were the chest in younger patients (81.9%) and the head and neck in patients aged ≥65 years (58.3%). Women’s mortality rates were similar to men (RR 1.8; 95% CI 0.7–4.9). Mortality was higher with age ≥65 years (RR 7.0; 95% CI 3.1–15.9), blunt trauma (RR 7.6; 95% CI 1.8–32.4) and Charlson Comorbidity Index of 1 or more (RR 3.2; 95% CI 1.3–8.0). The TRISS model performed well at lower ISS scores and was excellent at predicting survival (discrimination statistic 0.94). Conclusion Multiple factors influence mortality in major trauma patients in Trinidad and Tobago, including age, co-morbidities and injury mechanism. TRISS methodology accurately predicted survival in this population but was better at predicting mortality in patients with lower Injury Severity Score.
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Affiliation(s)
- Saleem Varachhia
- Emergency Department, San Fernando General Hospital, San Fernando, Trinidad and Tobago
| | | | - Joanne F Paul
- Clinical Surgical Sciences, Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Paula Robertson
- North Central Regional Health Authority, Champs Fleurs, Trinidad and Tobago
| | - Paula Nunes
- Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Ian Sammy
- Emergency Department, Scarborough General Hospital, Lower Scarborough, Trinidad and Tobago
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Hranjec T, Sawyer RG, Young JS, Swenson BR, Calland JF. Mortality Factors in Geriatric Blunt Trauma Patients: Creation of a Highly Predictive Statistical Model for Mortality Using 50,765 Consecutive Elderly Trauma Admissions from the National Sample Project. Am Surg 2020. [DOI: 10.1177/000313481207801229] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Elderly patients are at high risk for mortality after injury. We hypothesized that trauma benchmarking efforts would benefit from development of a geriatric-specific model for risk-adjusted analyses of trauma center outcomes. A total of 57,973 records of elderly patients (age older than 65 years), which met our selection criteria, were submitted to the National Trauma Database and included within the National Sample Project between 2003 and 2006. These cases were used to construct a multivariable logistic regression model, which was compared with the American College of Surgeons Committee on Trauma's Trauma Quality Improvement Project's (TQIP) existing model. Additional spline regression analyses were performed to further objectively quantify the physiologic differences between geriatric patients and their younger counterparts. The geriatric-specific and TQIP mortality models shared several covariates: age, Injury Severity Score, motor component of the Glasgow Coma Scale, and systolic blood pressure. Our model additionally used temperature and the presence of mechanical ventilation. Our geriatric-specific regression mode generated a superior c-statistic as compared with the TQIP approximation (0.85 vs 0.77; P = 0.048). Spline analyses demonstrated that elderly patients appear to be less likely to tolerate relative hypotension with higher observed mortality at initial systolic blood pressures of 90 to 130 mmHg. Although the TQIP model includes a single age component, these data suggest that each variable needs to be adjusted for age to more accurately predict mortality in the elderly. Clearly, a separate geriatric model for predicting outcomes is not only warranted, but necessary.
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Affiliation(s)
- Tjasa Hranjec
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert G. Sawyer
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Jeffrey S. Young
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Brian R. Swenson
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - James F. Calland
- Department of Surgery, University of Virginia, Charlottesville, Virginia
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One-year mortality in geriatric trauma patients: Improving upon the geriatric trauma outcomes score utilizing the social security death index. J Trauma Acute Care Surg 2020; 87:1148-1155. [PMID: 31318764 DOI: 10.1097/ta.0000000000002441] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Geriatric Trauma Outcomes Score (GTOS) predicts in-patient mortality in geriatric trauma patients and has been validated in a prospective multicenter trial and expanded to predict adverse discharge (GTOS II). We hypothesized that these formulations actually underestimate the downstream sequelae of injury and sought to predict longer-term mortality in geriatric trauma patients. METHODS The Parkland Memorial Hospital Trauma registry was queried for patients 65 years or older from 2001 to 2013. Patients were then matched to the Social Security Death Index. The primary outcome was 1-year mortality. The original GTOS formula (variables of age, Injury Severity Score [ISS], 24-hour transfusion) was tested to predict 1-year mortality using receiver operator curves. Significant variables on univariate analysis were used to build an optimal multivariate model to predict 1-year mortality (GTOS III). RESULTS There were 3,262 patients who met inclusion. Inpatient mortality was 10.0% (324) and increased each year: 15.8%, 1 year; 17.8%, 2 years; and 22.6%, 5 years. The original GTOS equation had an area under the curve of 0.742 for 1-year mortality. Univariate analysis showed that patients with 1-year mortality had on average increased age (75.7 years vs. 79.5 years), ISS (11.1 vs. 19.1), lower GCS score (14.3 vs. 10.5), more likely to require transfusion within 24 hours (11.5% vs. 31.3%), and adverse discharge (19.5% vs. 78.2%; p < 0.0001 for all). Multivariate logistic regression was used to create the optimal equation to predict 1-year mortality: (GTOSIII = age + [0.806 × ISS] + 5.55 [if transfusion in first 24 hours] + 21.69 [if low GCS] + 34.36 [if adverse discharge]); area under the curve of 0.878. CONCLUSION Traumatic injury in geriatric patients is associated with high mortality rates at 1 year to 5 years. GTOS III has robust test characteristics to predict death at 1 year and can be used to guide patient centered goals discussions with objective data. LEVEL OF EVIDENCE Prognostic, level III.
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22
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Emergency department visits resulting from electric scooter use in a major southeast metropolitan area. Emerg Radiol 2020; 27:469-475. [PMID: 32372167 DOI: 10.1007/s10140-020-01783-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the frequency, characteristics, and resource use related to the emergency department (ED) encounters resulting from electric scooter use in a major metropolitan area. METHODS This Institutional Review Board-approved study was conducted at a four-hospital healthcare system. Our clinical data warehouse was retrospectively searched from 5/3/2018 (the date electric scooters were introduced) through 8/15/2019 for various forms of the word "scooter" in triage notes. Demographic variables, arrival mode, length of stay, disposition, and resource utilization, including diagnostic radiology, were extracted. RESULTS Over the 471-day study window, 293 unique patients presented with e-scooter injuries (0.62 mean ED visits/day). When broken down into 8-h periods, there was a significant increase (p = 0.048) from Friday after 5 PM through Sunday night. Thirty-two percent of patients arrived at the ED during (newly enacted at the time of study) nighttime e-scooter ban hours (9 PM-4 AM). There was a range of one to nine diagnostic radiology examinations per patient, with 100% (293) of patients receiving at least one diagnostic radiology examination. A total of 710 diagnostic radiology examinations were performed on the entire cohort (mean 2.4 per patient): 77.2% (548) were radiographs and 22.1% (157) were computed tomography (CT). CONCLUSION ED visits resulting from electric scooter injuries are common and increasing. E-scooter injury patients disproportionately present on evenings and weekends, possibly exacerbating already busy periods in the ED. Healthcare resource needs and availability should be considered when developing policy about electric scooter use and distribution, particularly involving emergency care providers in close proximity to e-scooter distribution centers.
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Yadollahi M, Kashkooe A, Rezaiee R, Jamali K, Niakan MH. A Comparative Study of Injury Severity Scales as Predictors of Mortality in Trauma Patients: Which Scale Is the Best? Bull Emerg Trauma 2020; 8:27-33. [PMID: 32201699 PMCID: PMC7071938 DOI: 10.29252/beat-080105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To compare the injury severity scales as predictors of mortality in trauma patients to search for the best scale. Methods: In a prospective cohort study and systematical random sampling conducted from March to September 2017, trauma patients over the age of 13 years were enrolled. The investigated variables were age, gender, systolic blood pressure, heart rate, respiratory rate, injured body region, Glasgow Coma Scale (GCS), injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS) and the outcome. Results: Totally, 1410 trauma patients were followed up, out of which 68.5% were male. The participants’ mean age was 43.5±20.88 years. After adjusting the confounding effects, age over 60 years (OR=7.38, CI [3.91-13.93]), GCS<8 (OR=6.5, CI [2.38-18.16]), RTS<7.6 (OR=6.04, CI [2-13.7]), and TRISS<0.9 (OR=3.09, CI [1.39-6.88]) were determined as the most significant predictor variables for in-hospital mortality. The results of Receiver Operating Characteristic (ROC) curve revealed that TRISS had the highest area under the curve in comparison to other tests that were evaluated. Furthermore, TRISS had the highest sensitivity and specificity for scores higher than 96.15. By contrast, the sensitivity and specificity of GCS decreased for scores higher than 5.5. Conclusion: Our results showed that TRISS, RTS, GCS, and ISS were all very effective approaches for evaluating prognosis, mortality and probable complications in trauma patients; thus, these systems of injury evaluation and scoring are recommended to facilitate treatment. TRISS, RTS, and ISS had almost the same sensitivity that was higher than GCS, but GCS had the most specificity. Finally, TRISS was selected as the most efficient scale for predicting mortality.
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Affiliation(s)
- Mahnaz Yadollahi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kashkooe
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Rezaiee
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kazem Jamali
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kahnamoui K, Lysecki P, Uy C, Farrokhyar F, VanderBeek L, Akhtar-Danesh GG, Kahnamoui S, Sne N. The TRAAGIC score: early predictors of inpatient mortality in adult trauma patients. Can J Surg 2020; 63:E38-E45. [PMID: 31967443 DOI: 10.1503/cjs.016318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Scoring systems are important in prognostication and decision-making in the management of trauma patients. However, they often include an extensive list of factors not easily recalled by clinicians on admission. Additionally, multivariable analyses examining predictors of mortality in these patients is lacking. This study aimed to develop and validate a mortality prediction score for adult trauma inpatients. The intention was to create a scoring tool that could be easily remembered and implemented by clinicians. Methods This is a retrospective analysis of 5175 adult trauma patients treated at a level 1 trauma centre in Hamilton, Ontario, from 2002 to 2013. For derivation of the score, logistic regression was applied to data collected from 2002 to 2006 to identify potential predictors. Variables with p ≤ 0.10 identified from univariable analysis were entered in the multivariable logistic regression. Statistical significance was set at a value of 0.05. The prediction performance of the score was then assessed and validated on data for trauma patients treated from 2007 to 2013. The discrimination ability and calibration of the validation model were assessed. Frequencies, odds ratios with 95% confidence intervals (CIs) and C-statistics were reported. Results The TRAAGIC prediction score (transfusion, age, airway, hyperglycemia, international normalized ratio, creatinine) showed a C-index of 0.85 (95% CI 0.83–0.87) in the derivation cohort. The TRAAGIC score had high discrimination and good calibration when applied to the validation cohort. Conclusion The TRAAGIC score is an easily remembered and straightforward toolthat can reasonably predict inpatient mortality for adult trauma patients.
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Affiliation(s)
- Kamyar Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont. (K. Kahnamoui, Lysecki, Uy, Farrokhyar, Vander-Beek, Akhtar-Danesh, Sne); the Surgical Trauma Unit, Hamilton Health Sciences, Hamilton, Ont. (K. Kahnamoui, S. Kahnamoui, Sne); and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (Farrokhyar)
| | - Paul Lysecki
- From the Department of Surgery, McMaster University, Hamilton, Ont. (K. Kahnamoui, Lysecki, Uy, Farrokhyar, Vander-Beek, Akhtar-Danesh, Sne); the Surgical Trauma Unit, Hamilton Health Sciences, Hamilton, Ont. (K. Kahnamoui, S. Kahnamoui, Sne); and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (Farrokhyar)
| | - Cassandra Uy
- From the Department of Surgery, McMaster University, Hamilton, Ont. (K. Kahnamoui, Lysecki, Uy, Farrokhyar, Vander-Beek, Akhtar-Danesh, Sne); the Surgical Trauma Unit, Hamilton Health Sciences, Hamilton, Ont. (K. Kahnamoui, S. Kahnamoui, Sne); and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (Farrokhyar)
| | - Forough Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont. (K. Kahnamoui, Lysecki, Uy, Farrokhyar, Vander-Beek, Akhtar-Danesh, Sne); the Surgical Trauma Unit, Hamilton Health Sciences, Hamilton, Ont. (K. Kahnamoui, S. Kahnamoui, Sne); and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (Farrokhyar)
| | - Laura VanderBeek
- From the Department of Surgery, McMaster University, Hamilton, Ont. (K. Kahnamoui, Lysecki, Uy, Farrokhyar, Vander-Beek, Akhtar-Danesh, Sne); the Surgical Trauma Unit, Hamilton Health Sciences, Hamilton, Ont. (K. Kahnamoui, S. Kahnamoui, Sne); and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (Farrokhyar)
| | - Gileh-Gol Akhtar-Danesh
- From the Department of Surgery, McMaster University, Hamilton, Ont. (K. Kahnamoui, Lysecki, Uy, Farrokhyar, Vander-Beek, Akhtar-Danesh, Sne); the Surgical Trauma Unit, Hamilton Health Sciences, Hamilton, Ont. (K. Kahnamoui, S. Kahnamoui, Sne); and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (Farrokhyar)
| | - Sarah Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont. (K. Kahnamoui, Lysecki, Uy, Farrokhyar, Vander-Beek, Akhtar-Danesh, Sne); the Surgical Trauma Unit, Hamilton Health Sciences, Hamilton, Ont. (K. Kahnamoui, S. Kahnamoui, Sne); and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (Farrokhyar)
| | - Niv Sne
- From the Department of Surgery, McMaster University, Hamilton, Ont. (K. Kahnamoui, Lysecki, Uy, Farrokhyar, Vander-Beek, Akhtar-Danesh, Sne); the Surgical Trauma Unit, Hamilton Health Sciences, Hamilton, Ont. (K. Kahnamoui, S. Kahnamoui, Sne); and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (Farrokhyar)
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Hatton GE, McNutt MK, Cotton BA, Hudson JA, Wade CE, Kao LS. Age-Dependent Association of Occult Hypoperfusion and Outcomes in Trauma. J Am Coll Surg 2020; 230:417-425. [PMID: 31954820 DOI: 10.1016/j.jamcollsurg.2019.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Occult hypoperfusion (OH), or global hypoperfusion with normal vital signs, is a risk factor for poor outcomes in elderly trauma patients. We hypothesized that OH is associated with worse outcomes than shock in both young and elderly trauma patients. METHODS We conducted a single-center cohort study of adult (16 years or older) trauma patients from 2016 to 2018 with base excess measured on arrival. Perfusion states were defined as shock if heart rate was >120 beats/min or systolic blood pressure was <90 mmHg; OH if base excess was < -2 mmol/L, heart rate was <120 beats/min, and systolic blood pressure was >90 mmHg; and normal for all others. Patients were stratified as young (younger than 55 years) or elderly (55 years or older). Bayesian regression was used to assess the relationship between arrival perfusion state and mortality or serious complication. RESULTS Of 3,126 included patients, 808 were elderly. Rates of shock (33% and 31%) and OH (25% and 23%) were similar in young and elderly patients, respectively. OH on arrival was associated with higher odds of mortality or serious complication than normal perfusion, regardless of age group. Compared with shock, OH was associated with an odds ratio of 1.21 (95% CI, 0.97 to 1.52, posterior probability 96%) for poor outcomes in elderly patients and an odds ratio of 0.52 (95% CI, 0.42 to 0.65, posterior probability <1%) for poor outcomes in younger patients. Findings were similar on sensitivity analysis, excluding shock patients with base excess ≥ -2 mmol/L. CONCLUSIONS In elderly but not younger patients, OH is associated with worse outcomes than shock. Although shock parameters might need to be redefined in elderly patients, more attention is necessary for the diagnosis and treatment of all hypoperfused states in this age group.
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Affiliation(s)
- Gabrielle E Hatton
- Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX; McGovern Medical School, and Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX.
| | - Michelle K McNutt
- Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX; McGovern Medical School, and Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX
| | - Bryan A Cotton
- Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; McGovern Medical School, and Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX
| | - Jessica A Hudson
- Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX; McGovern Medical School, and Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX
| | - Charles E Wade
- Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; McGovern Medical School, and Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX
| | - Lillian S Kao
- Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX; McGovern Medical School, and Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX
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Peterer L, Ossendorf C, Jensen KO, Osterhoff G, Mica L, Seifert B, Werner CML, Simmen HP, Pape HC, Sprengel K. Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study. BMC Geriatr 2019; 19:359. [PMID: 31856739 PMCID: PMC6923826 DOI: 10.1186/s12877-019-1380-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 12/10/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. This study investigated whether the integration of new standard operating procedures (SOPs) for the resuscitation room (ER) has an impact on the clinical course in geriatric patients. The new SOPs were designed for severely injured adult trauma patients, based on the Advanced Trauma Life Support (ATLS) and imply early whole-body computed tomography (CT), damage control surgery, and the use of goal-directed coagulation management. METHODS Single-centre cohort study. We included all patients ≥65 years of age with an Injury Severity Score (ISS) ≥ 9 who were admitted to our hospital primarily via ER. A historic cohort was compared to a cohort after the implementation of the new SOPs. RESULTS We enrolled 311 patients who met the inclusion criteria between 2000 and 2006 (group PreSOP) and 2010-2012 (group SOP). There was a significant reduction in the mortality rate after the implementation of the new SOPs (P = .001). This benefit was seen only for severely injured patients (ISS ≥ 16), but not for moderately injured patients (ISS 9-15). There were no differences with regard to infection rates or rate of palliative care. CONCLUSIONS We found an association between implementation of new ER SOPs, and a lower mortality rate in severely injured geriatric trauma patients, whereas moderately injured patients did not obtain the same benefit. TRIAL REGISTRATION Clinicaltrials.gov NCT03319381, retrospectively registered 24 October 2017.
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Affiliation(s)
- Lorenz Peterer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christian Ossendorf
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Kai Oliver Jensen
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Georg Osterhoff
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Ladislav Mica
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Burkhardt Seifert
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Clément M. L. Werner
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hans-Peter Simmen
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Kai Sprengel
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Fernandez FB, Ong A, Martin AP, Schwab CW, Wasser T, Butts CA, McNicholas AR, Muller AL, Barbera CF, Trupp R, Sigal AP. Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria. Open Access Emerg Med 2019; 11:241-247. [PMID: 31754315 PMCID: PMC6825467 DOI: 10.2147/oaem.s212617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background Geriatric patients are at increased risk of injury following low-energy mechanisms and are less tolerant of injury. Current criteria for trauma team activation (TTA) often miss these injuries. We evaluated a novel triage process for an expedited Emergency Medicine Physician evaluation protocol (T3) for at-risk geriatric sub-populations not meeting trauma team activation (TTA) criteria. Methods Retrospective review of injured patients (≥65 years) from a Level II Trauma Center with an Injury Severity Score (ISS < 16), prior to (Pre-T3, Jan 2007-Oct 2009), and after (Post-T3, Jan 2010-Oct 2012), implementation of T3, as well as a contemporary period (CP, Jan 2013-Oct 2015). Demographics, physiologic variables, and timeliness of care were measured. Rates of ICU admission, operative procedures and lengths of stay and in-hospital mortality were compared for all periods. Logistic regression analysis determined variables independently associated with mortality. Results Post-T3, 49.2% of geriatric registry patients underwent T3 with a reduction in key time intervals. Median time to evaluation (42.1 mins vs 61.7 min, p<0.001), median time to CT (161.3 mins vs 212.9 mins, p<0.001) and EDLOS (364.6 mins vs 451.5 mins, p=0.023) were all reduced compared to non-expedited evaluations. There was no change in mortality after the implementation of the protocol. Conclusion The T3 protocol expedited patient evaluation of at-risk geriatric patients that would not otherwise meet TTA criteria. The new process met the goals of the American College of Surgeons Trauma Quality Improvement Program while conserving resources.
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Affiliation(s)
| | - Adrian Ong
- Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA
| | - Anthony P Martin
- Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA
| | - C William Schwab
- Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tom Wasser
- Complete Statistical Services, Macungie, PA, USA
| | | | | | - Alison L Muller
- Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA
| | - Charles F Barbera
- Department of Emergency Medicine, Reading Hospital, Reading, PA, USA
| | - Rachael Trupp
- Department of Emergency Medicine, Reading Hospital, Reading, PA, USA
| | - Adam P Sigal
- Department of Emergency Medicine, Reading Hospital, Reading, PA, USA
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Lee HH, Cho JS, Lim YS, Hyun SY, Woo JH, Jang JH, Yang HJ. Relationship between age and injury severity in traffic accidents involving elderly pedestrians. Clin Exp Emerg Med 2019; 6:235-241. [PMID: 31571439 PMCID: PMC6774005 DOI: 10.15441/ceem.18.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/08/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to examine whether injury severity differs with respect to age among elderly pedestrians involved in traffic accidents and identify factors affecting injury severity. METHODS Using emergency department-based injury in-depth surveillance data, we analyzed the data of patients aged ≥60 years who were victims of pedestrian traffic accidents during 2011 to 2016. The pedestrians' ages were divided into 5-year age strata beginning at 60 years. In a multivariate analysis, injury severity was classified as severe to critical or mild to moderate. RESULTS The analysis included 10,449 patients. All age groups had a female predominance, and accidents most frequently occurred during the early morning. Multivariate analyses revealed that compared to the 60 to 64 years group, the odds ratios for incurring a severe injury were 1.18 (95% confidence interval [CI], 1.02 to 1.37) for the 65 to 69 years group, 1.42 (95% CI, 1.23 to 1.64) for the 70 to 74 years group, 1.70 (95% CI, 1.45 to 1.98) for the 75 to 79 years group, and 1.83 (95% CI, 1.56 to 2.15) for the ≥80 years group. CONCLUSION In this study of emergency department-based data, we found that injury severity increased with age among elderly victims of traffic accidents. Furthermore, injury severity varied with respect to sex, time and location of the accident, and type of vehicle involved. Therefore, measures intended to reduce and prevent traffic accidents involving elderly pedestrians should consider these findings.
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Affiliation(s)
- Hyog Ho Lee
- Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Jin-Seong Cho
- Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yong Su Lim
- Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sung Youl Hyun
- Department of Traumatology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae-Hyug Woo
- Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae Ho Jang
- Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Hyuk Jun Yang
- Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Lee JH, Lee DH. Comparison of injury pattern and clinical outcomes between young adults and elderly patients with alcohol-related injury in South Korea 2011-2016. PeerJ 2019; 7:e7704. [PMID: 31579598 PMCID: PMC6768054 DOI: 10.7717/peerj.7704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
Background Alcohol is an important factor that contributes to emergency department (ED) visits due to injury. However, the role of alcohol in elderly patients visiting ED due to injury has not been clearly defined. This study aims to examine age and alcohol as risk factors of injury severity and clinical outcomes. Methods This study included patients who visited EDs between January 2011 and December 2016. Data was obtained from the Emergency Department-Based Injury In-depth Surveillance of the Korea Centers for Disease Control and Prevention, South Korea. Injury patients aged ≥18 years were included, but those who visited the ED more than 48 hours after injury, with unknown clinical outcomes (admission, mortality, and excess mortality ratio-adjusted injury severity score [EMR-ISS]) were excluded. Results We analyzed 887,712 patients, of whom 131,708 (17.7%) non-elderly and 9,906 (7.0%) elderly had alcohol-related injury. Falls and slips are the most common injury mechanism (37.9%) in patients consuming alcohol (36.3% non-elderly/58.40% elderly). The injury occurred on roads (40.6%), houses (33.8%), and commercial facilities (11.9%) in elderly patients consuming alcohol. Suicide rate was 12.0% in elderly and 9.7% in non-elderly patients. According to the time of day of injury, evening (60.8%) was the most common in elderly and night (62.6%) in non-elderly patients. Admission rate (odds ratio [OR] 2.512 confidence interval [CI] 2.407–2.621), intensive care unit (ICU) care rate (OR 5.507 [CI] 5.178–5.858), mortality rate (OR 4.593 [CI] 4.086–5.162), and EMR-ISS >25 (OR 5.498 [CI] 5.262–5.745) were compared between patients with alcohol-related injury and non-elderly with non-alcohol-related injury patients. Alcohol consumption in elderly patients results in significant impairment and increases EMR-ISS, ICU care rate, and mortality rate. To reduce injury in elderly patients, alcohol screening, appropriate counseling, and intervention are needed.
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Affiliation(s)
- Jae Hee Lee
- Department of Emergency Medicine, Ewha Womans University, Seoul, South Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University, Seoul, South Korea
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Cassignol A, Marmin J, Cotte J, Cardinale M, Bordes J, Pauly V, Kerbaul F, Demory D, Meaudre E. Correlation between field triage criteria and the injury severity score of trauma patients in a French inclusive regional trauma system. Scand J Trauma Resusc Emerg Med 2019; 27:71. [PMID: 31382982 PMCID: PMC6683531 DOI: 10.1186/s13049-019-0652-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/26/2019] [Indexed: 11/17/2022] Open
Abstract
Background In France, the pre-hospital field triage of trauma patients is currently based on the Vittel criteria algorithm. This algorithm was originally created in 2002 before the stratification of trauma centers and, at the national level, has not been revised since. This could be responsible for the overtriage of trauma patients in Level I Trauma Centers. The principal aim of this study was to evaluate the correlation between each Vittel field triage criterion and trauma patients’ Injury Severity Score. Methods Our Level I Trauma Center receives an average of 300 trauma patients per year. Demographic and physiological data, along with the entire trauma patient management process and Vittel field triage criteria, are recorded in a local trauma registry. The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are calculated after a complete assessment of the trauma victim during their in-hospital management. Results were concerned with the presence of an ISS of greater than 15, which defined a major trauma patient; mortality within 30 days; and admission to the intensive care unit. This study is a registry analysis from January 2013 to September 2017. Results Of the 1373 patients in the registry, 1151 were included in the analysis with a mean age of 43 years (± 19) and a median ISS of 13 (IQR = 5–22), where 887 (77%) were male. Nine of the 24 Vittel criteria were associated with an ISS > 15. In a multivariate analysis, no criterion related to kinetic elements was significantly correlated with an ISS > 15, mortality within 30 days, or admission to intensive care. Three algorithm categories were predictive of a major trauma patient (ISS > 15): physiological variables, pre-hospital resuscitation, and physical injuries, while kinetic elements were not. Conclusions Criteria related to physiological variables, pre-hospital resuscitation, and physical injuries are the most relevant to predicting the severity of a trauma patient’s condition. A revision of the VCA could potentially have beneficial effects on the over and undertriage phenomena, which constitute ongoing medical and financial concerns.
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Affiliation(s)
- Arnaud Cassignol
- SMUR Department, Sainte-Musse Public Hospital, 83100, Toulon, cedex 9, France.
| | - Julien Marmin
- Prehospital Emergency Medical Services of Marine Fire Battalion, Marseille, France
| | - Jean Cotte
- Anesthesia and Intensive Care Department, Sainte-Anne Military Hospital, 83041, Toulon, France
| | - Mickael Cardinale
- Anesthesia and Intensive Care Department, Sainte-Anne Military Hospital, 83041, Toulon, France
| | - Julien Bordes
- Anesthesia and Intensive Care Department, Sainte-Anne Military Hospital, 83041, Toulon, France
| | - Vanessa Pauly
- Public Health and Medical Information Service, Conception Hospital, Aix-Marseille University, 13005, Marseille, France
| | - François Kerbaul
- SMUR department, Timone Hospital, Aix-Marseille University, 13005, Marseille, France.,UMR MD 2, Aix-Marseille University, Marseille, France
| | - Didier Demory
- Clinical research unit, Sainte-Musse Public Hospital, 83100, Toulon, cedex 9, France
| | - Eric Meaudre
- Anesthesia and Intensive Care Department, Sainte-Anne Military Hospital, 83041, Toulon, France
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Lange N, Rothlauf P, Jörger AK, Wagner A, Meyer B, Shiban E. Craniocervical trauma above the age of 90: are current prognostic scores sufficient? Neurosurg Rev 2019; 43:1101-1107. [PMID: 31197623 DOI: 10.1007/s10143-019-01130-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 01/10/2023]
Abstract
Clinical data following head or spine trauma in patients over 90 years is rare. The aim of this study was to analyze this patient cohort, assessing clinical characteristics, outcomes, and survival rates and to identify variables that may predict early mortality. A retrospective analysis of all patients over the age of 90 that were treated between January 2006 and December 2016 at our department was performed. Patient characteristics, type of injury, and comorbidities were analyzed with regard to the 30-day mortality rate as the primary outcome. One hundred seventy-nine patients were identified. Mean age was 93 (range 90-102); 105 (59%) patients were female. One hundred thirty-two (74%) and 34 (19%) of patients presented with head and spinal trauma, respectively. Fourteen patients (8%) had a combined head and spine injury. One hundred (56%) patients were treated operatively. Mean Charlson comorbidity index was 4.1 (range 0-18), mean diagnosis count was 6.2 (range 0-12), mean geriatric index of comorbidity (GIC) was 3.3 (range 1-4), and mean Barthel index was 28 (range 0-100). The 30-day mortality rate was 31%. Multivariate cox regression analysis showed that head trauma had a 1.66 hazard ratio (p = 0.036) of dying within 30 days of admission, whereas a higher Glasgow coma score and surgical treatment had a hazard ratio of 0.88 (p = 0.0001) and 0.72 (p = 0.05) to reach the primary outcome. None of the standard geriatric scores reached any significant correlation with the primary outcome. Standard geriatric prognostic scores seem less reliable to predict mortality for patients above the age of 90. Higher Glasgow coma score and surgical treatment were associated with a higher survival probability.
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Affiliation(s)
- Nicole Lange
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Paulina Rothlauf
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ann-Kathrin Jörger
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ehab Shiban
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
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Patel DC, Dhillon NK, Linaval N, Patel K, Margulies DR, Ley EJ, Barmparas G. Data-Driven Opportunity to Reduce Elderly Pedestrian Trauma. Am Surg 2019. [DOI: 10.1177/000313481908500521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Elderly patients are at high risk for mortality after injury, and prevention is imperative. Several studies have captured the value of traffic calming or environmental modifications; however, limited data support its use during focused times of the day to reduce pedestrian trauma. This study's aim was to identify when the elderly are more likely to be injured from pedestrian trauma. The Los Angeles County Trauma and Emergency Medicine Information System database was reviewed for all adult pedestrians who were struck by vehicles from 2000 to 2015. Elderly (≥65 years) patients were compared with nonelderly (range, 18–64 years) patients with respect to the time of admission and mortality. The proportion of elderly pedestrian injuries peaked between 9 and 10 am (23%). Compared with their nonelderly counterparts, the elderly were more likely to have a Glasgow Coma Scale ≤8 (11% vs 7%, P < 0.01), be hypotensive (6% vs 3%, P < 0.01), and have a higher Injury Severity Score (median 9 vs 5, P < 0.01). Mortality was significantly higher in the elderly (14% vs 4%, P < 0.01). Elderly pedestrians had an almost 5-fold higher adjusted odds ratio for death: 4.72 ( P < 0.01). Preventative strategies with lower speed limits or high surveillance during these hours in highly populated areas may result in a decreased incidence of these injuries.
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Affiliation(s)
- Deven C. Patel
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Navpreet K. Dhillon
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nikhil Linaval
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kavita Patel
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel R. Margulies
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric J. Ley
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Galinos Barmparas
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Naeem Z, McCormack JE, Huang EC, Vosswinkel JA, Shapiro MJ, Zarlasht F, Jawa RS. Impact of Type and Number of Complications on Mortality in Admitted Elderly Blunt Trauma Patients. J Surg Res 2019; 241:78-86. [PMID: 31015071 DOI: 10.1016/j.jss.2019.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/01/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Advanced age and comorbidities are recognized risk factors for adverse outcomes in elderly trauma patients. However, the contribution of the number and type of complications to in-hospital mortality in elderly blunt trauma admissions has not been extensively studied. METHODS A retrospective review of the trauma registry at a level 1 trauma center for blunt trauma patients age ≥65 y hospitalized for at least 2 d between 2010 and 2015. RESULTS There were 2467 admissions, with a median age of 81 y and median injury severity score of 9. The most common mechanism of injury was a low-level fall. Approximately 19.6% of admissions had a complication: 11.1% major complications, 8.6% other complications. The in-hospital mortality rate was significantly different (P < 0.001) among the three groups at 16.1% of major complications group, 7.1% of other, and 2.1% of no complications (P < 0.001). On multivariate logistic regression, each major complication increased the odds for in-hospital mortality by 1.59-fold. CONCLUSIONS Complications are not infrequent in elderly blunt trauma admissions, despite a generally lower energy mechanism of injury. Each major complication is associated with increased odds of mortality. Multifaceted interventions for prevention and mitigation of complications are indicated.
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Affiliation(s)
- Zaina Naeem
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Jane E McCormack
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Emily C Huang
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - James A Vosswinkel
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Marc J Shapiro
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Fnu Zarlasht
- Division of Geriatric Medicine, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York
| | - Randeep S Jawa
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York.
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Ali Ali B, Brinck T, Handolin L, Belzunegui Otano T. Severe head injury in elderly: 6-year comparison of treatment and outcome between southern Finland and Navarra (Spain). Eur J Trauma Emerg Surg 2019; 47:1429-1436. [PMID: 30747276 DOI: 10.1007/s00068-019-01091-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/07/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the profile, treatment and outcome of elderly patients with severe traumatic brain injuries (TBI) between southern Finland and Navarra (Spain). METHODS Data collected from, 2010 to 2015, in the Major Trauma Registry of Navarra (MTR-N) and the Helsinki Trauma Registry (HTR) were compared. Patients with New Injury Severity Score (NISS) ≥ 16 and age ≥ 65 with isolated severe TBI were considered. Patients who had been admitted to the hospital ≥ 24 h after the trauma, had been pronounced dead before hospital arrival, or had been injured by hanging, drowning or burns, were excluded. Outcome was defined by 30-day hospital mortality. The expected mortality was calculated using the Revised Injury Severity Classification score II (RISC II). Other compared data included demographics, injury mechanism, pre-hospital and hospital treatment, and time intervals. RESULTS A total of 305 (MTR-N) and 137 (HTR) patients were included in the outcome analysis. The standardized mortality ratio with 95% confidence interval was for MTR-N 1.4 (1.1-1.6) and for HTR 0.8 (0.6-1.1). Patients in Navarra were older (average 79.7 vs. 75.0) while in southern Finland the percentage of pre-hospital intubation in patients with GCS ≤ 8 (75.0% vs 50.0%) and ICU admission (72.2% vs 22.0%) were higher. CONCLUSION The better adjusted outcome of elderly patients with severe TBI in southern Finland in comparison to Navarra could be due to higher rate of pre-hospital intubation and/or higher rate of ICU admissions in southern Finland. Increasing number of elderly patients with severe TBI necessitate uniformly accepted protocols in pre- and in-hospital management.
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Affiliation(s)
- Bismil Ali Ali
- Accident and Emergency Department, Complejo Hospitalario de Navarra, Health service of Navarra-Osasunbidea, 31011, Pamplona, Spain.
| | - Tuomas Brinck
- Trauma Unit, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lauri Handolin
- Trauma Unit, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tomas Belzunegui Otano
- Accident and Emergency Department, Complejo Hospitalario de Navarra, Health service of Navarra-Osasunbidea, 31011, Pamplona, Spain.,Department of Health, Public University of Navarra, Pamplona, Spain
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Geriatric Acetabular Surgery: Letournel's Contraindications Then and Now-Data From the German Pelvic Registry. J Orthop Trauma 2019; 33 Suppl 2:S8-S13. [PMID: 30688853 DOI: 10.1097/bot.0000000000001406] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In his original series of 129 surgically treated acetabular fractures, Letournel did not operate on patients older than 60 years. Almost 30 years later, he still emphasized that no patients with reduced bone quality should be operated on. The aim of the study was to analyze epidemiologic characteristics and treatment modes for today's cohort of elderly patients with acetabular fractures. DESIGN Retrospective analysis. SETTING Multicenter registry/Level I trauma center. PATIENTS Three thousand seven hundred ninety-three patients who had sustained a fracture of the acetabulum. INTERVENTION Operative and nonoperative treatment of acetabular fractures. MAIN OUTCOME MEASUREMENTS Epidemiologic characteristics, treatment mode, in-hospital mortality, rate of secondary hip arthroplasty, and quality of life indicated by EQ-5D score. RESULTS For the multicenter registry, more than 50% of all patients with acetabular fractures had an age of 60 years or over. The age peak was found at 75-80 years. Fifty percent of the elderly patients were treated surgically. The in-hospital mortality was significantly higher in elderly patients than patients younger than 60 years. In our Level I trauma center, surgical treatment by open reduction and internal fixation did not influence in-hospital mortality or quality of life of elderly patients with acetabular fractures. CONCLUSIONS Today, elderly persons represent the dominant cohort among patients with fractures of the acetabulum. Fifty-five years after the publication of Letournel's original case series, data indicate that currently, surgical treatment is a common and necessary option in the therapy of acetabular fractures in elderly patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Javali RH, Krishnamoorthy, Patil A, Srinivasarangan M, Suraj, Sriharsha. Comparison of Injury Severity Score, New Injury Severity Score, Revised Trauma Score and Trauma and Injury Severity Score for Mortality Prediction in Elderly Trauma Patients. Indian J Crit Care Med 2019; 23:73-77. [PMID: 31086450 PMCID: PMC6487611 DOI: 10.5005/jp-journals-10071-23120] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives This study tests the accuracy of the Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS) and Trauma and Injury Severity Score (TRISS) in prediction of mortality in cases of geriatric trauma. Design Prospective observational study. Materials and methods This was a prospective observational study on two hundred elderly trauma patients who were admitted to JSS Hospital, Mysuru over a consecutive period of 18 months between December 2016 to May 2018. On the day of admission, data were collected from each patient to compute the ISS, NISS, RTS, and TRISS. Results Mean age of patients was 66.35 years. Most common mechanism of injury was road traffic accident (94.0%) with mortality of 17.0%. The predictive accuracies of the ISS, NISS, RTS and the TRISS were compared using receiver operator characteristic (ROC) curves for the prediction of mortality. Best cutoff points for predicting mortality in elderly trauma patient using TRISS system was a score of 91.6 (sensitivity 97%, specificity of 88%, area under ROC curve 0.972), similarly cutoff point under the NISS was score of 17(91%, 93%, 0.970); for ISS best cutoff point was at 15(91%, 89%, 0.963) and for RTS it was 7.108(97%,80%,0.947). There were statistical differences among ISS, NISS, RTS and TRISS in terms of area under the ROC curve (p <0.0001). Conclusion TRISS was the strongest predictor of mortality in elderly trauma patients when compared to the ISS, NISS and RTS. How to cite this article Javali RH, Krishnamoorthy et al. Comparison of Injury Severity Score, New Injury Severity Score, Revised Trauma Score and Trauma and Injury Severity Score for Mortality Prediction in Elderly Trauma Patients. Indian J of Crit Care Med 2019;23(2):73-77.
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Affiliation(s)
- Rameshbabu Homanna Javali
- Department of Emergency Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Krishnamoorthy
- Department of Emergency Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Akkamahadevi Patil
- Department of Emergency Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Madhu Srinivasarangan
- Department of Emergency Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Suraj
- Department of Emergency Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Sriharsha
- Department of Emergency Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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Culp BL, Roden-Foreman JW, Thomas EV, McShan EE, Bennett MM, Martin KR, Powers MB, Foreman ML, Petrey LB, Warren AM. Better with age? A comparison of geriatric and non-geriatric trauma patients' psychological outcomes 6 months post-injury. Cogn Behav Ther 2018; 48:406-418. [PMID: 30392449 DOI: 10.1080/16506073.2018.1533578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This is the first study to compare both physical and psychological outcomes in geriatric and non-geriatric patients (n = 268) at baseline and 6 months post-trauma. Demographic, clinical, and psychological data, including screens for alcohol use, depressive symptoms, and post-traumatic stress symptoms (PTSS) were collected from 67 geriatric patients (70.7 ± 8.0 years) and 201 non-geriatric patients (40.2 ± 12.8 years) admitted to a Level I trauma center for ≥ 24 h. Geriatric patients were significantly less likely to screen positive for alcohol use at baseline, and depression, PTSS, and alcohol use at follow-up. When not controlling for discharge to rehabilitation or nursing facility, geriatric patients had significantly lower odds of alcohol use at follow-up. There was no significant difference in injury severity, resilience, or pre-trauma psychological status between the two groups. Results indicate that geriatric trauma patients fare better than their younger counterparts at 6 months post-trauma on measures of alcohol use, depression, and PTSS. Screenings and interventions for both age groups could improve psychological health post-trauma, but younger patients may require additional attention.
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Affiliation(s)
- Brittney L Culp
- a Department of Surgery, Baylor Scott & White - Grapevine , Grapevine , TX , USA
| | - Jacob W Roden-Foreman
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Estrella V Thomas
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Evan Elizabeth McShan
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Monica M Bennett
- c Baylor Scott & White Health, Center for Clinical Effectiveness , Dallas , TX , USA
| | - Katherine Riley Martin
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Mark B Powers
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Michael L Foreman
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Laura B Petrey
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Ann Marie Warren
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
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Hu P, Uhlich R, White J, Kerby J, Bosarge P. Sarcopenia Measured Using Masseter Area Predicts Early Mortality following Severe Traumatic Brain Injury. J Neurotrauma 2018; 35:2400-2406. [DOI: 10.1089/neu.2017.5422] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Parker Hu
- Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rindi Uhlich
- Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jared White
- Division of Transplant Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey Kerby
- Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patrick Bosarge
- Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Verhoeff K, Glen P, Taheri A, Min B, Tsang B, Fawcett V, Widder S. Implementation and adoption of advanced care planning in the elderly trauma patient. World J Emerg Surg 2018; 13:40. [PMID: 30202429 PMCID: PMC6127940 DOI: 10.1186/s13017-018-0201-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Geriatric trauma has high morbidity and mortality, often requiring extensive hospital stays and interventions. The number of geriatric trauma patients is also increasing significantly and accounts for a large proportion of trauma care. Specific geriatric trauma protocols exist to improve care for this complex patient population, who often have various comorbidities, pre-existing medications, and extensive injury within a trauma perspective. These guidelines for geriatric trauma care often suggest early advanced care planning (ACP) discussions and documentation to guide patient and family-centered care. Methods A provincial ACP program was implemented in April of 2012, which has since been used by our level 1 trauma center. We applied a before and after study design to assess the documentation of goals of care in elderly trauma patients following implementation of the standardized provincial ACP tool on April 1, 2012. Results Documentation of ACP in elderly major trauma patients following the implementation of this tool increased significantly from 16 to 35%. Additionally, secondary outcomes demonstrated that many more patients received goals of care documentation within 24 h of admission, and 93% of patients had goals of care documented prior to intensive care unit (ICU) admission. The number of trauma patients that were admitted to the ICU also decreased from 17 to 5%. Conclusion Early advanced care planning is crucial for geriatric trauma patients to improve patient and family-centered care. Here, we have outlined our approach with modest improvements in goals of care documentation for our geriatric population at a level 1 trauma center. We also outline the benefits and drawbacks of this approach and identify the areas for improvement to support improved patient-centered care for the injured geriatric patient. Here, we have provided a framework for others to implement and further develop. Electronic supplementary material The online version of this article (10.1186/s13017-018-0201-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Verhoeff
- 1Faculty of Medicine and Dentistry, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - P Glen
- 2Department of Surgery, 2D4.27 Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - A Taheri
- 2Department of Surgery, 2D4.27 Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - B Min
- 1Faculty of Medicine and Dentistry, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - B Tsang
- 2Department of Surgery, 2D4.27 Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - V Fawcett
- 2Department of Surgery, 2D4.27 Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - S Widder
- 2Department of Surgery, 2D4.27 Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
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Clinical Outcome and Management for Geriatric Traumatic Injury: Analysis of 2688 Cases in the Emergency Department of a Teaching Hospital in Taiwan. J Clin Med 2018; 7:jcm7090255. [PMID: 30181469 PMCID: PMC6162823 DOI: 10.3390/jcm7090255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/23/2018] [Accepted: 09/03/2018] [Indexed: 01/06/2023] Open
Abstract
Geriatric traumatic injuries in emergency departments are frequent and associated with higher mortality rates and catastrophic functional outcomes. Several prediction scores have been established to manage traumatic patients, including the shock index (SI), revised trauma score (RTS), injury severity score (ISS), trauma injury severity score (TRISS), and new injury severity score (NISS). However, it was necessary to investigate the effectiveness and efficiency of care for the geriatric traumatic population. In addition, image studies such as computed tomography and magnetic resonance imaging play an important role in early diagnosis and timely intervention. However, few studies focus on this aspect. The association between the benefit of carrying out more image studies and clinical outcomes remains unclear. In this study, we included a total of 2688 traumatic patients and analyzed the clinical outcomes and predicting factors in terms of geriatric trauma via pre-hospital and in-hospital analysis. Our evaluation revealed that a shock index ≥1 may be not a strong predictor of geriatric trauma due to the poor physical response in the aging population. This should be modified in geriatric patients. Other systems, like RTS, ISS, TRISS, and NISS, were significant in terms of predicting the clinical outcome.
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Sepehripour S, Duggineni S, Shahsavari S, Dheansa B. Life expectancy in elderly patients following burns injury. Burns 2018; 44:1446-1450. [DOI: 10.1016/j.burns.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/05/2018] [Accepted: 04/08/2018] [Indexed: 01/28/2023]
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Nordgarden T, Odland P, Guttormsen AB, Ugelvik KS. Undertriage of major trauma patients at a university hospital: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2018; 26:64. [PMID: 30107855 PMCID: PMC6092794 DOI: 10.1186/s13049-018-0524-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/02/2018] [Indexed: 12/12/2022] Open
Abstract
Background Studies show increased mortality among severely injured patients not met by trauma team. Proper triage is important to ensure that all severely injured patients receive vital trauma care. In 2017 a new national trauma plan was implemented in Norway, which recommended the use of a modified version of “Guidelines for Field Triage of Injured Patients” to identify severely injured patients. Methods A retrospective study of 30,444 patients admitted to Haukeland University Hospital in 2013, with ICD-10 injury codes upon discharge. The exclusion criteria were department affiliation considered irrelevant when identifying trauma, patients with injuries that resulted in Injury Severity Score < 15, patients that did receive trauma team, and patients admitted > 24 h after time of injury. Information from patient records of every severely injured patient admitted in 2013 was obtained in order to investigate the sensitivity of the new guidelines. Results Trauma team activation was performed in 369 admissions and 85 patients were identified as major trauma. Ten severely injured patients did not receive trauma team resuscitation, resulting in an undertriage of 10.5%. Nine out of ten patients were men, median age 54 years. Five patients were 60 years or older. All of the undertriaged patients experienced fall from low height (< 4 m). Traumatic brain injury was seen in six patients. Six patients had a Glasgow Coma Scale score ≤ 13. The new trauma activation guidelines had a sensitivity of 95.0% in our 2013 trauma population. The degree of undertriage could have been reduced to 4.0% had the guidelines been implemented and correctly applied. Conclusions The rate of undertriage at Haukeland University Hospital in 2013 was above the recommendations of less than 5%. Use of the new trauma guidelines showed increased triage precision in the present trauma population.
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Affiliation(s)
- Terje Nordgarden
- Faculty of Medicine, University of Bergen, Haukelandsveien 28, 5009, Bergen, Norway.
| | - Peter Odland
- Faculty of Medicine, University of Bergen, Haukelandsveien 28, 5009, Bergen, Norway
| | - Anne Berit Guttormsen
- Department of Clinical Medicine 1, Jonas Lies vei 65, 5021, Bergen, Norway.,Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Kristina Stølen Ugelvik
- Regional Trauma Center, Surgical Department, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
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Impact of early positive cultures in the elderly with traumatic brain injury. J Surg Res 2017; 224:140-145. [PMID: 29506830 DOI: 10.1016/j.jss.2017.11.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/30/2017] [Accepted: 11/10/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the United States, especially in the elderly, who have the highest rates of TBI-related hospitalizations and deaths among all age groups. Sepsis is one of many risk factors that is associated with higher mortality and longer length of hospital stay in this population partially due to the immunosuppressive effects of TBI. The significance of early indicators of infection, such as a positive blood, sputum, or urine culture, is not well described. The purpose of this study was to determine if early positive cultures predict higher mortality in elderly patients with TBI. METHODS All trauma patients aged ≥65 years with TBI, admitted between January 1, 2009 and December 31, 2013 to the surgical intensive care unit, were retrospectively reviewed. Clinical data including results from sputum, blood, and urine cultures were reviewed. RESULTS Overall, 288 elderly patients with TBI were identified, and 92 (32%) had a positive culture. Patients with positive cultures had longer intensive care unit (median 6.0 versus 2.0 days, P < 0.001) and ventilation days (median 7.0 versus 2.0 days, P < 0.001). Patients who had positive cultures within 2-3 days of admission had a higher adjusted hazard ratio for mortality than those patients who had positive cultures after 6 or more days. CONCLUSIONS In elderly patients with TBI, early positive cultures are associated with a higher risk of mortality. Further research is required to determine the role of obtaining cultures on admission in this subpopulation of trauma patients.
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Cheng CH, Yim WT, Cheung NK, Yeung JHH, Man CY, Graham CA, Rainer TH. Differences in Injury Pattern and Mortality between Hong Kong Elderly and Younger Patients. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790901600405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The rapidly aging population in Hong Kong is causing an impact on our health care system. In Hong Kong, 16.5% of emergency department trauma patients are aged ≥65 years. Objective We aim to compare factors associated with trauma and differences in trauma mortality between elderly (≥65 years) and younger adult patients (15 to 64 years) in Hong Kong. Methods A retrospective observational study was performed using trauma registry data from the Prince of Wales Hospital, a 1200–bed acute hospital which is a regional trauma centre. Results A total of 2172 patients (331 [15.2%] elderly and 1841 [84.8%] younger) were included. Male patients predominated in the younger adult group but not in the elderly group. Compared with younger patients, elderly patients had more low falls and pedestrian-vehicle crashes and sustained injuries to the head, neck and extremities more frequently. The odds ratio (OR) for death following trauma was 5.5 in the elderly group (95% confidence interval [CI] 3.4–8.9, p>0.0001). Mortality rates increased progressively with age (p>0.0001) and were higher in the elderly at all levels of Injury Severity Score (ISS). Age ≥65 years independently predicted mortality (OR=5.7, 95% CI 3.5–9.3, p>0.0001). The elderly had a higher co-morbidity rate (58.6% vs. 14.1%; p>0.01). There was a lower proportion of trauma call activations for the elderly group (38.6% vs. 53.3%; p>0.01). Conclusion Elderly trauma patients differ from younger adult trauma patients in injury patterns, modes of presentation of significant injuries and mortality rates. In particular, the high mortality of elderly trauma requires renewed prevention efforts and aggressive trauma care to maximise the chance of survival.
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Lai CH, Lai CH, Chen KH, Wang CH, Hsiao CT, Hsiao KY. Comparison of Mortality among Severe Trauma Patients Treated in a Trauma Centre versus a Non-Trauma Centre. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction In Taiwan, patients with major trauma are often sent to the closest non-trauma centre for initial resuscitation and transferred to distant trauma centres subsequently. This study aimed to evaluate the in-hospital mortality of severe trauma patients treated in a trauma centre versus in a non-trauma centre. Methods This prospective observational study reviewed 223 patients with major trauma (defined as Injury Severity Scale [ISS] score >15) who visited either a Level I trauma centre or a non-trauma centre from April 2013 to March 2014. Data of clinical status, trauma mechanisms, laboratory and radiology, interventions, and mortality/survival were evaluated. Logistic regression analysis was performed to assess effects of initial hospital treatment on mortality. Results A total of 158 major trauma patients were taken to the trauma centre hospital, and 65 patients were taken to the non-trauma centre. Age > 70 years (odds ratio [OR] 6.24, 95% confidence interval [CI] 1.01 to 38.62, compared to age ≤40 years), Glasgow Coma Scale [GCS] 3-8 (OR 19.00, 95% CI 2.30-157.01, compared to GCS 13-15), GCS 9-12 (OR 28.88, 95% CI 4.40-189.86, compared to GCS 13-15), ISS score >25 (OR 6.95, 95% CI 1.27-38.08) and taken to non-trauma centre initially (OR 30.90, 95% CI 5.00-191.27) were significantly associated with mortality. Conclusion Initial treatment of patients with major trauma in a non-trauma centre was associated with increased mortality compared to initial treatment in a trauma centre.
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Affiliation(s)
- CH Lai
- Chang Gung Memorial Hospital, Department of Emergency Medicine, Chiayi, Taiwan
| | - CH Lai
- Chang Gung Memorial Hospital, Department of Radiation Oncology, Chiayi, Taiwan
| | - KH Chen
- Chang Gung Memorial Hospital, Department of Physical Medicine and Rehabilitation, Chiayi and Chang Gung University, School of Medicine, Taoyuan, Taiwan
| | - CH Wang
- Chang Gung Memorial Hospital, Department of Emergency Medicine, Chiayi, Taiwan
| | - CT Hsiao
- Chang Gung Memorial Hospital, Department of Emergency Medicine and Chang Gung University, School of Traditional Chinese Medicine, College of Medicine, Taiwan
| | - KY Hsiao
- Chang Gung Memorial Hospital, Department of Emergency Medicine; and Chang Gung University of Science and Technology, Department of Nursing, Chiayi, Taiwan
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Joseph B, Jehan FS. The Mobility and Impact of Frailty in the Intensive Care Unit. Surg Clin North Am 2017; 97:1199-1213. [DOI: 10.1016/j.suc.2017.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cheung A, Haas B, Ringer TJ, McFarlan A, Wong CL. Canadian Study of Health and Aging Clinical Frailty Scale: Does It Predict Adverse Outcomes among Geriatric Trauma Patients? J Am Coll Surg 2017; 225:658-665.e3. [PMID: 28888692 DOI: 10.1016/j.jamcollsurg.2017.08.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The Canadian Study of Health and Aging Clinical Frailty Scale (CFS) and the laboratory Frailty Index (FI-lab) are validated tools based on clinical and laboratory data, respectively. Their utility as predictors of geriatric trauma outcomes is unknown. Our primary objective was to determine whether pre-admission CFS is associated with adverse discharge destination. Secondary objectives were to evaluate the relationships between CFS and in-hospital complications and between admission FI-lab and discharge destination. STUDY DESIGN We performed a 4-year (2011 to 2014) retrospective cohort study with patients 65 years and older admitted to a level I trauma center. Admission FI-lab was calculated using 23 variables collected within 48 hours of presentation. The primary outcome was discharge destination, either adverse (death or discharge to a long-term, chronic, or acute care facility) or favorable (home or rehabilitation). The secondary outcome was in-hospital complications. Multivariable logistic regression was used to evaluate the relationship between CFS or FI-lab and outcomes. RESULTS There were 266 patients included. Mean age was 76.5 ± 7.8 years and median Injury Severity Score was 17 (interquartile range 13 to 24). There were 260 patients and 221 patients who had sufficient data to determine CFS and FI-lab scores, respectively. Pre-admission frailty as per the CFS (CFS 6 or 7) was independently associated with adverse discharge destination (odds ratio 5.1; 95% CI 2.0 to 13.2; p < 0.001). Severe frailty on admission, as determined by the FI-lab (FI-lab > 0.4), was not associated with adverse outcomes. CONCLUSIONS Pre-admission clinical frailty independently predicts adverse discharge destination in geriatric trauma patients. The CFS may be used to triage resources to mitigate adverse outcomes in this population. The FI-lab determined on admission for trauma may not be useful.
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Affiliation(s)
- Annie Cheung
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Barbara Haas
- Department of Surgery and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario
| | - Thom J Ringer
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario
| | | | - Camilla L Wong
- Division of Geriatric Medicine, St Michael's Hospital, Toronto, Ontario.
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KARIBE H, HAYASHI T, NARISAWA A, KAMEYAMA M, NAKAGAWA A, TOMINAGA T. Clinical Characteristics and Outcome in Elderly Patients with Traumatic Brain Injury: For Establishment of Management Strategy. Neurol Med Chir (Tokyo) 2017; 57:418-425. [PMID: 28679968 PMCID: PMC5566701 DOI: 10.2176/nmc.st.2017-0058] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/18/2017] [Indexed: 01/21/2023] Open
Abstract
In recent years, instances of neurotrauma in the elderly have been increasing. This article addresses the clinical characteristics, management strategy, and outcome in elderly patients with traumatic brain injury (TBI). Falls to the ground either from standing or from heights are the most common causes of TBI in the elderly, since both motor and physiological functions are degraded in the elderly. Subdural, contusional and intracerebral hematomas are more common in the elderly than the young as the acute traumatic intracranial lesion. High frequency of those lesions has been proposed to be associated with increased volume of the subdural space resulting from the atrophy of the brain in the elderly. The delayed aggravation of intracranial hematomas has been also explained by such anatomical and physiological changes present in the elderly. Delayed hyperemia/hyperperfusion may also be a characteristic of the elderly TBI, although its mechanisms are not fully understood. In addition, widely used pre-injury anticoagulant and antiplatelet therapies may be associated with delayed aggravation, making the management difficult for elderly TBI. It is an urgent issue to establish preventions and treatments for elderly TBI, since its outcome has been remained poor for more than 40 years.
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MESH Headings
- Accidental Falls/statistics & numerical data
- Age Factors
- Aged
- Aged, 80 and over
- Anticoagulants/adverse effects
- Atrophy
- Brain/pathology
- Brain/physiopathology
- Brain Damage, Chronic/epidemiology
- Brain Damage, Chronic/etiology
- Brain Damage, Chronic/prevention & control
- Brain Edema/etiology
- Brain Edema/physiopathology
- Brain Injuries, Traumatic/complications
- Brain Injuries, Traumatic/epidemiology
- Brain Injuries, Traumatic/physiopathology
- Brain Injuries, Traumatic/therapy
- Comorbidity
- Disease Management
- Disease Progression
- Humans
- Hyperemia/physiopathology
- Intracranial Hemorrhage, Traumatic/etiology
- Intracranial Hemorrhage, Traumatic/physiopathology
- Platelet Aggregation Inhibitors/adverse effects
- Practice Guidelines as Topic
- Subdural Space/pathology
- Treatment Outcome
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Affiliation(s)
- Hiroshi KARIBE
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Toshiaki HAYASHI
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Ayumi NARISAWA
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Motonobu KAMEYAMA
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Atsuhiro NAKAGAWA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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van Rein EAJ, Houwert RM, Gunning AC, Lichtveld RA, Leenen LPH, van Heijl M. Accuracy of prehospital triage protocols in selecting severely injured patients: A systematic review. J Trauma Acute Care Surg 2017; 83:328-339. [PMID: 28452898 DOI: 10.1097/ta.0000000000001516] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prehospital trauma triage ensures proper transport of patients at risk of severe injury to hospitals with an appropriate corresponding level of trauma care. Incorrect triage results in undertriage and overtriage. The American College of Surgeons Committee on Trauma recommends an undertriage rate below 5% and an overtriage rate below 50% for prehospital trauma triage protocols. To find the most accurate prehospital trauma triage protocol, a clear overview of all currently available protocols and corresponding outcomes is necessary. OBJECTIVES The aim of this systematic review was to evaluate the current literature on all available prehospital trauma triage protocols and determine accuracy of protocol-based triage quality in terms of sensitivity and specificity. METHODS A search of Pubmed, Embase, and Cochrane Library databases was performed to identify all studies describing prehospital trauma triage protocols before November 2016. The search terms included "trauma," "trauma center," or "trauma system" combined with "triage," "undertriage," or "overtriage." All studies describing protocol-based triage quality were reviewed. To assess the quality of these type of studies, a new critical appraisal tool was developed. RESULTS In this review, 21 articles were included with numbers of patients ranging from 130 to over 1 million. Significant predictors for severe injury were: vital signs, suspicion of certain anatomic injuries, mechanism of injury, and age. Sensitivity ranged from 10% to 100%; specificity from 9% to 100%. Nearly all protocols had a low sensitivity, thereby failing to identify severely injured patients. Additionally, the critical appraisal showed poor quality of the majority of included studies. CONCLUSION This systematic review shows that nearly all protocols are incapable of identifying severely injured patients. Future studies of high methodological quality should be performed to improve prehospital trauma triage protocols. LEVEL OF EVIDENCE Systematic review, level III.
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Affiliation(s)
- Eveline A J van Rein
- From the Department of Traumatology (E.A.J.V.R., A.C.G., L.P.H.L., M.V.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Utrecht Trauma Center (R.M.H.), Utrecht, The Netherlands; and Regional Ambulance Facilities Utrecht (R.L.), RAVU, Utrecht, The Netherlands
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Kim SC, Kim DH, Kim TY, Kang C, Lee SH, Jeong JH, Park YJ, Lee SB, Lim D. The Revised Trauma Score plus serum albumin level improves the prediction of mortality in trauma patients. Am J Emerg Med 2017. [PMID: 28637583 DOI: 10.1016/j.ajem.2017.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Revised Trauma Score (RTS) is used worldwide in prehospital practice and in the emergency department (ED) settings to triage trauma patients. The main purpose of this study was to evaluate the value of the RTS plus serum albumin (RTS-A) and to compare it with other existing trauma scores as well as to compare the predictive performance of the Trauma and Injury Severity Score with the RTS-A (TRISS-A) with the original TRISS. METHODS This was a single center, trauma registry based observational cohort study. Data were collected from consecutive patients with blunt or penetrating injuries who presented to the emergency department of a tertiary referral hospital, between January 2012 and June 2016. 3145 and 2447 patients were assigned to the derivation group and validation group, respectively. Main outcome was in-hospital mortality. RESULTS Among patients in the derivation group, the median [interquartile range] age was 59 [43-73] years, and 66.7% were male. The area under the receiver operating characteristic curves (AUC) of the RTS-A (0.948; 95% CI: 0.939-0.955) was higher than that of the RTS (0.919; 95% CI: 0.909-0.929). In patients with blunt trauma, the AUC of the TRISS-A (0.960; 95% CI: 0.952-0.967) was significantly higher than that of the original TRISS (0.949; 95% CI: 0.941-0.957). CONCLUSION The value of the RTS-A predicts the in-hospital mortality of trauma patients better than the RTS, and the TRISS-A is a better mortality predictor compared to the original TRISS in patients with blunt trauma.
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Affiliation(s)
- Seong Chun Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Dong Hoon Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea.
| | - Tae Yun Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea
| | - Soo Hoon Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea
| | - Jin Hee Jeong
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea
| | - Yong Joo Park
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Sang Bong Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea
| | - Daesung Lim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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