The evaluation of geriatric patients who presented with trauma to the emergency department

Follow-Up Chest X-rays in Minor Chest Trauma with Fewer Than Three Rib Fractures: A Justifiable, Habitual Re-Imaging Industry?

Objective: We evaluated the necessity of follow-up chest X-rays (CXRs) to exclude a pneumothorax after 1 week of initial hospital presentation in patients with no signs of respiratory distress and fewer than three rib fractures. Materials and Methods: Adult patients with fewer than three fractured ribs who presented at our Level I trauma center between 2015 and 2017 were evaluated retrospectively. Patients with sternal fractures, who had suffered a polytrauma, or were primarily treated with a chest tube were excluded. The patients' and fractures' characteristics, trauma mechanism, median follow-up time, and the number of required secondary interventions were recorded. Results: This study included 249 patients, 137 (55.0%) of whom were male, with a median age of 64.34 years. In 150 patients (60.2%) one rib was affected, in 99 patients (39.8%) two ribs were affected, with the fractured ribs being true ribs (1-7) in 72 cases (28.9%), false ribs (8-12) in 151 cases (60.6%), and both in 26 cases (10.4%). The affected thorax half was the left side in 124 cases (49.8%) and both thorax halves in 4 cases (1.6%). The median follow-up time was 9 ± 4 days. In the follow-up CXRs, six patients (1.6%) required delayed intervention (tube thoracostomy): one case of hemopneumothorax and five cases of pneumothorax. All of the patients fully recovered. Conclusions: Planned CXR follow-ups revealed only a small number of complications that needed intervention and therefore seem not to be necessary. Symptom-triggered reappearance seems to be more sufficient and economical compared to habitual reimaging.

Stepping into Trouble: Craniomaxillofacial Trauma in the Geriatric Population From Stairway Falls

PURPOSE

The purpose of this study is to determine what potential factors are associated with increased risk of hospital admission among the geriatric population who suffer stairway falls.

MATERIALS AND METHODS

This is a 10-year cross-sectional study that was conducted using the National Electronic Injury Surveillance System (NEISS). Entries whose primary product was categorized under the code 1239 (stairs or steps) were included in this study. Reports were excluded if the injury did not occur within the craniomaxillofacial region. The principal outcome variable was admission rate. Patient and injury characteristics were compared using χ2 and independent sample t tests.

RESULTS

Admission rates were significantly associated with sex (P < .01), age group (P < .01), race (P < .05), craniomaxillofacial region (P < .01), and primary diagnosis (P < .01). Relative to the females, males (OR, 1.458; P < .01) were independently associated with an increased odds of admission. Relative to patients aged 65 to 69 years old, patients aged 70 to 79 (OR, 1.247; P < .01), 80 to 89 (OR, 1.438; P < .01), and 90 & over (OR, 1.569; P < .01) were each independently associated with an increased odds of admission. Relative to white patients, black patients (OR, 1.238; P < .01) were each independently associated with an increased odds of admission. Relative to mouth injuries, eyeball injuries (OR, 4.574; P < .01) and head injuries (OR, 4.105; P < .01) were independent risk factors for admission. Relative to abrasions, fractures (OR, 6.013; P < .01) and internal organ injuries (OR, 4.814; P < .01) were each independently associated with an increased odds of admission.

CONCLUSIONS

Age, gender, craniomaxillofacial region, type of injury, and primary diagnosis are all independent risk factors for hospital admissions. Preventative measures need to be taken to safeguard the older geriatric population from craniomaxillofacial trauma associated with stairway falls.

Impact of chronic medical conditions on mortality in geriatric trauma, 10-year analysis of a single centre in Turkey

BACKGROUND

The healthy and active lifestyle adopted by the elderly as a result of improvements in the standards of living may lead to an increase in the risk of injury. Comorbidities increase the risk of posttraumatic complications and mortality. The aim of this study was to investigate the impact of chronic medical conditions (CMCs) on the risk of mortality in geriatric trauma patients.

METHODS

All geriatric trauma patients admitted to emergency department over a 10-year period were retrospectively analysed. Patients were stratified by baseline characteristics, injury severity score (ISS), presence of CMCs, and in-hospital mortality. Multivariate logistic regression was used to determine variables significantly associated with in-hospital mortality.

RESULTS

9455 patients included in the study. The median age was 74 (10) years and 57% of them were female. The presence of ≥1 CMC and ≥2 CMCs increased the risk of mortality 5.64 and 2.38 times respectively in mild traumas and 2.67 and 2.59 times respectively in moderate traumas. Age, ISS and penetrating traumas had a significant impact on the risk of mortality in all ISS groups. In severe traumas, only renal disease had an impact on the risk of mortality (OR = 2.58, 95%CI = 1.03-6.43, p = 0.042). All other CMCs, ≥1 CMC, and ≥2 CMCs had no impact on the risk of mortality.

CONCLUSION

The presence of CMCs in elderly patients with mild and moderate injuries increases the risk of mortality. Such patients should be diagnosed and treated more quickly and aggressively during the prehospital process and in the hospital.

Frailty Syndrome in Patients With Lower Extremity Amputation: Simplifying How We Calculate Frailty

BACKGROUND

Frailty syndrome is an established predictor of adverse outcomes after surgical procedures. Our study aimed to compare the simplified National Surgical Quality Improvement Program 5-factor-modified frailty index (mFI-5) to its prior 11-factor-modified frailty index (mFI-11) with respect to the predictive ability for mortality, postoperative complications, and unplanned 30-d readmission in patients undergoing lower limb amputation.

METHODS

The National Surgical Quality Improvement Program (2005-2012) databank was queried for all geriatric patients (>65 y) who underwent above-knee and below-knee amputations. We calculated each mFI by dividing the number of factors present for a patient by the total number of available factors. To assess the correlation between the mFI-5 and mFI-11, we used Spearman's rho rank coefficient. We then compared the two indices for each outcome (30-d complication, 30-d mortality, and 30-d readmission) and C-Statistic using predictive models.

RESULTS

A total of 8681 patients were included with mean age of 76 ± 9 y, complication rate 35.8%, mortality rate 10.2%, and readmission rate 15.9%. There was no difference in type of amputation in frail and nonfrail. Correlation between the mFI-5 and mFI-11 was above 0.9 for all outcome measures. Both mFI-5 and mFI-11 indexes had strong predictive ability for mortality, postoperative complications, and 30-d readmissions.

CONCLUSIONS

In patients undergoing major lower limb amputation, we found mFI-5 and the mFI-11 were equally effective in predicting postoperative outcomes. Frailty remained a strong predictor of postoperative complications, mortality, and 30-d readmission.

Usefulness of mean platelet volume to platelet count ratio for predicting the risk of mortality in community-acquired pneumonia

INTRODUCTION

The association between mean platelet volume (MPV) to platelet count (PC) ratio and prognosis has been demonstrated in some diseases but not in community-acquired pneumonia (CAP). In this study, we evaluated the ability of MPV to PC ratio (MPR) to predict short-term mortality in CAP patients.

MATERIAL AND METHODS

We retrospectively analysed data archived over 10 years and stratified MPR values into quartiles. Relations between MPR (femtoliters/number of thousand platelets per microlitre) quartiles and 60-day mortality were examined. Logistic regression was performed to adjust for confounders, and the Kaplan-Meier method was used for survival analysis.

RESULTS

After adjusting for confounding factors, the odds ratios of 60-day mortality for CAP were 2.66 (95% CI: 2.04-3.46) for the fourth MPR quartile (range ≥ 5.19; p < 0.001) versus the first MPR quartile (range ≤ 2.45). Kaplan-Meier curves indicated that a higher MPR was associated with a higher risk of mortality among CAP patients, and this was confirmed by the log-rank test (p < 0.001).

CONCLUSIONS

Mean platelet volume to PC ratio was found to be positively correlated with short-term mortality. Our data indicate that MPR might be a significant predictive marker of the mortality in CAP. Further prospective studies are required to establish the exact role of MPR in CAP and other diseases.

The global burden of pancreatic cancer

INTRODUCTION

We provide here an overview on current worldwide epidemiology of pancreatic malignancies, obtained from Global Health Data Exchange (GHDx) and World Health Organization (WHO) repositories.

MATERIAL AND METHODS

Electronic searches for collecting information on pancreatic cancer epidemiology were performed in official repositories of GHDx and WHO, and retrieved data were then analyzed.

RESULTS

Overall, 447 665 new cases of pancreatic cancer were recorded around the world in 2017 (58.6 per million), with global prevalence of 49.8 per million and 441 083 deaths (57.7 per million). Incidence, prevalence and mortality increased by 55%, 63% and 53% during the last 25 years. Pancreatic cancer accounts for 1.8% of all cancers, causing 3.9% of all cancer disability- adjusted life years (DALYs) and 4.6% of all cancer deaths. No sex differences can be observed for incidence, prevalence and mortality, whilst DALYs are marginally higher in men. Incidence, prevalence and mortality follow a similar age-related trend, with gradual escalation after 30 years of age, reaching the highest burden after 80 years of age. The DALYs peak between 55 and 74 years, and then decline. The epidemiologic burden is positively associated with socio-demographic status. The largest burden of pancreatic cancers is observed in the East and Asia Pacific region, whilst the lowest is found in the Middle East and North Africa. Pancreatic cancer deaths are expected to increase by ~1.97-fold by the year 2060.

CONCLUSIONS

Although pancreatic cancer remains relatively infrequent, its clinical, societal and economic burden is noteworthy. Future projections suggest that its burden may double during the next 40 years.

[Reconstruction of lower limbs in old age-an interdisciplinary approach : Geriatric assessment, perioperative management, diagnostics and treatment targets]

Complex injuries of the lower extremities in geriatric patients with multiple pre-existing comorbidities represent an increasing challenge to an interdisciplinary team of surgeons. Functional reconstruction of the extremity through osteosynthesis, revascularization and defect coverage aims to preserve mobility and achieve an early return to activities of daily life at home, while avoiding major amputation and the associated risks regarding morbidity and mortality. An interdisciplinary assessment of geriatric patients regarding dystrophy of soft tissue and skín, cardiovascular and metabolic comorbidities as well as specific geriatric diagnostics are crucial steps in ensuring favorable outcomes. Perioperatively, all improvable risk factors should be actively optimized and a specialized interdisciplinary approach to treatment planning (extremity board) is absolutely necessary for success of treatment. It outlines the special features of the geriatric assessment, diagnostics, perioperative management and treatment targets.