Injury Characteristics and Outcomes in Elderly Trauma Patients in Sub‐Saharan Africa

Gallaher, Jared; Haac, Bryce; Geyer, Andrew J.; Mabedi, Charles; Cairns, Bruce A.; Charles, Anthony

doi:10.1007/s00268-016-3622-y

Cited by 15 publications

(19 citation statements)

References 46 publications

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“…Compared to HICs, where more than 15% of trauma patients are elderly, the cohort of elderly patients admitted to the trauma unit during the study period made up a relatively small portion of the total number of trauma admissions [8, 20, 30–32]. In line with our findings, the few studies conducted in LMICs attributed less than 10% of trauma admissions to the elderly population [33–35].…”

Section: Discussionsupporting

confidence: 84%

“…That said, intentionally inflicted injuries (due to community assault) and certain preventable MOIs (e.g., fall from height and PVCs) were common in our study, compared to findings from HICs [8, 23, 24, 37]. Studies conducted in LMICs showed similar assault rates to the current study [2, 32, 33, 35]. High assault rates may reflect the high crime rates, limited resources, and the relatively few programs in the public sector aimed at elderly trauma prevention evident in LMICs, such as SA, in contrast to most HICs [1, 45, 46].…”

Section: Discussionsupporting

confidence: 73%

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

Breedt

Steyn

2022

World j. surg.

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Background Little is known about the injury profile of older persons from low‐and‐middle‐income countries, such as South Africa, where violence is prevalent. This study aimed to identify common mechanisms of injury (MOI), severity, complications, and outcomes in elderly patients admitted to a referral trauma centre in Cape Town. Methods A retrospective review was performed of all patients ≥60 years presenting at Tygerberg hospital trauma centre over an eight‐month period. Descriptive statistics were computed for all variables of interest, and the relationship between the MOI, injury severity score (ISS), complications, and outcomes were assessed. Results Of the total 7,635 trauma cases admitted, patients ≥60 years accounted for 4% (n = 275). The most frequent MOI was low falls (58%). Of these 11% of injuries were intentionally inflicted. Among them 35% of the patients experienced complications. The ISS was positively associated with the number of complications (p < 0.01). The mortality rate was 6.5%. An ISS of ≥10 was associated with increased mortality (p < 0.01). The number of complications was positively associated with mortality (p < 0.01). Conclusions In contrast to high‐income countries (HICs), the cohort of elderly patients admitted to the trauma centre made up a relatively small portion of the total admissions. Compared to HICs, intentionally inflicted injuries and preventable MOI were common in our sample, underscoring the importance of addressing causative factors. Notably, the ISS was strongly associated with the number of complications and an ISS ≥10 was associated with mortality, highlighting the utility of the ISS in identifying elderly trauma patients most at risk of negative outcomes.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 73%

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

Breedt

Steyn

2022

World j. surg.

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“…Also, we should limit our prescription to the most needed medicines, and choose from the once daily intake or the most simple drug regimens [10]. In this case, adding twice daily vitamin B (that can be forgone) erroneously induced this elderly woman to quadruple her anti-hypertensive medicine with the risk of hypotension and falls [5, 6, 11]. Patients on ACEIs, especially the elderly, should monitored regularly for late onset adverse drug reactions [7].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple drug use combined with their fragile health predisposes them to adverse drug reactions, drug-drug interactions, and direct drug toxicity from potential overdosing [3]. They may even sustain physical injuries with eventual poor outcomes as a result of medicine use [4–6]. We report and discuss the lessons learnt from the case of an elderly woman in an urban setting in sub-Saharan Africa, who presented with problems of drug dosing, adverse drug effect, and drug-drug interaction that might prove useful in the future management of hypertension with angiotensin converting enzyme inhibitors (ACEIs).…”

Section: Introductionmentioning

confidence: 99%

A case management of hypertension in the elderlyin sub-Sahara Africa: lessons from Granny

2017

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Management of chronic disease conditions in the elderly is challenging. They usually have many co-morbidities requiring multiple drug regimens, and memory or cognitive problems that can interfere with management. Also, they sometimes have a degree of social problems as they might often live alone, and thereby cater for their daily activities with minimal assistance. Multiple drug use combined with their fragile health predispose them to adverse drug reactions, drug-drug interactions, and direct drug toxicity from overdosing. We report and discuss the lessons learnt from the case of an elderly woman in an urban setting in sub-Saharan Africa who presented with problems of drug dosing, adverse drug effect, and drug-drug interaction that might prove useful in the future management of hypertension with angiotensin converting enzyme inhibitors.

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“…3 Geriatric trauma in South Africa is almost certainly overshadowed by trauma in the young, and consequently under-reported in the literature. 11 Interpersonal violence (IPV) against the elderly is common and frequently under-reported. Paradoxically, there is very limited literature in South Africa that specifically focuses on this area.…”

Section: Introductionmentioning

confidence: 99%

The neglected epidemic of trauma from interpersonal violence against the elderly in South Africa

Lee¹,

Kong²,

Cheung³

et al. 2022

South African Journal of Surgery

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BACKGROUND: Geriatric injuries comprise a significant burden in the developed world but much less are known in the developing world setting. This study aims to review our experience of geriatric injuries with a focus on interpersonal violence (IPV) managed at a major trauma centre in South Africa. METHODS: This was a retrospective study on all patients who were aged > 65 years admitted to our trauma centre from January 2013 to December 2020, based in Pietermaritzburg, South Africa. RESULTS: Over the 8-year study period, 323 cases were included (62% male, mean age 72 years). Mechanism of injury: 80% blunt, 16% penetrating and 4% others. The median injury severity score (ISS) was 9. The median Charlson comorbidity index (CCI) for all 323 cases was 3. Diabetes (n = 53) was the most prevalent comorbidity which was followed by pulmonary disease (n = 23), cerebral vascular accidents (n = 16) and myocardial infarction (n = 15). Fifteen patients were on antiretroviral therapy (5%). Twenty-four per cent required surgical intervention. Eight per cent of cases experienced one or more complications. Twenty-five per cent (80/323) were related to IPV, 61% (49/80) of these were penetrating injuries and the remaining 31 cases were blunt injuries. Of the 49 cases of penetrating injuries, 33 were gunshot wounds (GSWs) and 16 were stab wounds (SWs) (1 GSW and 2 SWs were self-inflicted and were not included in IPV). Those cases that resulted from IPV were significantly more likely to require operative intervention, experience complications and longer lengths of hospital stay. Geriatric patients had poorer outcomes than non-geriatric patients and rural geriatric patients had worse outcomes than urban geriatric patients. CONCLUSION: Although the burden of geriatric trauma in South Africa appears to be relatively low, it is associated with significant morbidity and mortality. Trauma from interpersonal violence is especially common and is associated with significantly worse outcomes than that of non-interpersonal violence-related trauma. Elderly rural trauma victims have worse outcomes than their urban counterparts

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Injury Characteristics and Outcomes in Elderly Trauma Patients in Sub‐Saharan Africa

Abstract: Elderly trauma in a resource-poor area in sub-Saharan Africa is associated with a significant increase in hospital admissions and mortality. Significant improvements in trauma systems, pre-hospital care, and hospital capacity for older, critically ill patients are imperative.

Cited by 15 publications

References 46 publications

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

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

A case management of hypertension in the elderlyin sub-Sahara Africa: lessons from Granny

The neglected epidemic of trauma from interpersonal violence against the elderly in South Africa

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