Clinical Factors in Geriatric Blunt Trauma

Abstract

SUMMARY Objectives This study aimed to determine the clinical factors that contribute to the admission, management, and outcome of blunt trauma to geriatric patients. Methods This prospective, cross sectional study was conducted at a tertiary Emergency Department (ED) Results The study included 406 geriatric patients (268 (66%) female) with a mean age of all patients being 75.6±7 years (65-102 years). Extremities and head injury were the most common injury sites. The femoral neck was the most common fracture site (24%). Low velocity fall (LVF) was the most common mechanism of blunt trauma (79%). Advancing age was also significantly related with LVF incidence, fracture incidence and ISS ≥9. Five patients died in the hospital (1.2%). Conclusions ÖZET AmaçÇalışmamızın amacı acil servisimize künt travma nedeni ile başvu-ran 65 yaş ve üstü hastaların başvuru, müdahale ve sonlanmasında-ki klinik faktörlerin incelenmesidir. Gereç ve YöntemÇalışmamız Ocak-Nisan 2012 tarihleri arasında, 3. basamak acil servisinde yapılan ileriye yönelik, kesitsel bir çalışmadır. Çalışmaya 65 yaş ve üstü, künt travma nedeni ile başvuran hastalar kabul edildi. Hastaların demografik verileri, yandaş hastalıkları, kullandığı ilaç sayıları, yaralanma mekanizması, son 6 ay içinde travma öyküsü, yaralanma bölgesi, yaralanma ağırlık skoru (ISS), hastane kalım süreleri, hastane sonlanımları veri toplama formuna kaydedildi. BulgularÇalışmaya 406 hasta kabul edildi (n=268, %66 kadın). Yaş ortalaması 75.6±7 (dağılım 65-102 yaş) idi. En sık yaralanma bölgesi ekstremiteler ve baş idi. Femur kırıkları en sık saptanan kırıklardı (%24). Düşük enerjili düşmeler (DED) en sık (%79) travma mekanizması idi. Yaş artışı ile DED, kırık oluşumu ve ISS≥9 olma insidansının arttığı belirlendi. Tüm hastaların 5'i hayatını kaybetti (%1.2). Sonuç DED, geriatrik künt travmada birincil etyolojiyi oluşturdu. En sık yaralanma bölgesi baş ve ekstremitelerdi ve ekstremitelerde en sık femur kırıkları saptandı. İleri yaş ve 5 ve üstü ilaç kullanımı kırık oluşumu için, kadın cinsiyet DED için bağımsız risk faktörleri olarak saptandı. İleri yaş ve inme öyküsü travma ağırlığı ile ilişkili bulundu.Anahtar sözcükler: Acil servis; geriatrik hasta; klinik özellikler; künt travma.

Polypharmacy and risk of fractures in older adults: A systematic review

“…Selection bias may also have led to underestimating the association between polypharmacy and risk of fractures. Studies including emergency department visits or hospitalized individuals, 28,29,32,38,40,47,49,57 who are more likely to be exposed to polypharmacy than the target population, may have overrepresented non-cases exposed to polypharmacy. 66,67 Furthermore, no strategy to control for attrition was employed in cohort studies, which may result in biased estimates due to unbalanced mortality rates between the exposed and unexposed groups.…”

“…Sample size varied from 50 26 to 2,997,872 27 individuals (Table 1). Hip fractures was the most studied outcome (n = 16 (17 articles) 26,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] ), followed by all bone fractures (n = 12 27,[44][45][46][47][48][49][50][51][52][53][54] ), upper limb fractures (n = 2 55,56 ), and fragility fractures (n = 1 57 ). In 13 studies, the association between polypharmacy and fractures was not the primary objective.…”

“…In 13 studies, the association between polypharmacy and fractures was not the primary objective. 29,[32][33][34][39][40][41][42]47,51,[54][55][56] The source of medication data was mainly prescriptions or self-report, but 11 studies used medication claims, 27,28,31,[34][35][36][37]44,46,53,54 and the source was unknown in one study. 39…”

“…There was a very high level of heterogeneity in the way polypharmacy was defined across studies. Firstly, three methods were used to calculate medications: simultaneous use (n = 15 (16 articles)), 26,[28][29][30][41][42][43]45,[47][48][49]51,52,[55][56][57] cumulative use…”

Effect of coolant spray on rib fracture pain of geriatric blunt thoracic trauma patients: a randomized controlled trial

“…The effectiveness of analgesic therapies applied in treating pain due to rib fractures has been discussed in the literature for many years. The most commonly studied analgesic methods were interventional ones 10,11 . Since the physical characteristics of each traumatized patient will not be the same, it may be necessary to develop special treatment protocols for different populations.…”