Injury patterns and outcomes in late middle age (55–65): The intersecting comorbidity with high-risk activity – A retrospective cohort study

Gale, Stephen C.; Peters, JoAnn; Murry, Jason; Crystal, Jessica S.; Dombrovskiy, Viktor Y.

doi:10.1016/j.amsu.2018.01.005

Cited by 8 publications

(9 citation statements)

References 19 publications

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“…The rate of hypertension also increased from 12% in those younger than 55 years to 53.6% in the 55 to 76 years age group. These two findings are similar to a study conducted by Gale et al,24 who compared the outcomes of late middle age trauma patients relative to younger and older patients. Gale et al24 found the rate of diabetes to be 5.2% in those younger than 55 years, which increased to a rate of 20.3% in trauma patients aged 55 to 65 years, and the rate of hypertension increased from 13.0% in patients younger than 55 years to 41.8% in the 55 to 65 years age category.…”

supporting

confidence: 90%

“…Previous studies have indicated an increase in comorbidities among those 55 years or older, 23,24 which may provide further insight regarding the mechanism behind the increase in mortality of those at this consequential age. Compared with those under the age of 55 years, this study also determined a statistically and clinically significant increase in the mean number of comorbidities, with the rate of comorbidities doubling in trauma patients older than 55 years.…”

Section: Discussionmentioning

confidence: 91%

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Redefining geriatric trauma: 55 is the new 65

Fakhry

Morse

Garland

et al. 2021

J Trauma Acute Care Surg

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As the prevalence of geriatric trauma patients has increased, protocols are being developed to address the unique requirements of this demographic. However, categorical definitions for geriatric patients vary, potentially creating confusion concerning which patients should be cared for according to geriatric-specific standards. The aim of this study was to identify data-driven cut points for mortality based on age to support implementation of age-driven guidelines. METHODS:Adults aged 18 to 100 years with blunt or penetrating injury were selected from 95 hospitals' trauma registries. Change point analysis techniques were used to detect inflection points in the proportion of deaths at each age. Based on these calculated points, patients were allocated into age groups, and their characteristics and outcomes were compared. Logistic regression was used to estimate risk-adjusted in-hospital mortality controlling for sex, race, Injury Severity Score, Glasgow Coma Scale, and number of comorbidities. RESULTS: A total of 255,099 patients were identified (female, 45.7%; mean age, 59.3 years; mean Injury Severity Score, 8.69; blunt injury, 92.6%). Statistically significant increases in mortality rate were noted at ages 55, 77, and 82 years. Compared with the referent group (age, <55 years), adjusted odds ratios (AORs) showed increases in mortality if age 55 to 76 years (AOR, 2.42), age 77 to 81 years (AOR, 4.70), or age 82 years or older (AOR, 6.43). National Trauma Data Standard-defined comorbidities significantly increased once age surpassed 55 years, as the rate more than doubled for each of the older age categories (p < 0.001). As age increased, each group was more likely to be female, have dementia, sustain a ground level fall, and be discharged to a skilled nursing facility (p < 0.001). CONCLUSION:This large multicenter analysis established a clinically and statistically significant increase in mortality at ages 55, 77, and 82 years. This research strongly suggests that trauma patients older than 55 years be considered for inclusion in geriatric trauma protocols.The other age inflection points identified (77 and 82 years) may also warrant additional specialized care considerations.

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supporting

confidence: 90%

Section: Discussionmentioning

confidence: 91%

Redefining geriatric trauma: 55 is the new 65

Fakhry

Morse

Garland

et al. 2021

J Trauma Acute Care Surg

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“…Falls were the dominating trauma mechanism (55%) with a marked increase from age group 50 years in line with recent studies (Steyerberg et al 2019 ). The late middle-aged (50–70 years) have recently been identified as a risk group, as they intersect with increasing comorbidity on one hand and keeping up physical and social activity on the other (Gale et al 2018 ; Peeters et al 2019 ). Thus, fall-preventing strategies ought to include this age-group as well.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of traumatic brain injury patients with abnormal neuroimaging in Southeast Norway

et al. 2020

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Background: The vast majority of hospital admitted patients with traumatic brain injury (TBI) will have intracranial injury identified by neuroimaging, requiring qualified staff and hospital beds. Moreover, increased pressure in health care services is expected because of an aging population. Thus, a regular evaluation of characteristics of hospital admitted patients with TBI is needed. Oslo TBI Registry-Neurosurgery prospectively register all patients with TBI identified by neuroimaging admitted to a trauma center for southeast part of Norway. The purpose of this study is to describe this patient population with respect to case load, time of admission, age, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival. Methods: Data for 5 years was extracted from Oslo TBI Registry-Neurosurgery. Case load, time of admission, age, sex, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival was compiled and compared. Results: From January 1st, 2015 to December 31st, 2019, 2153 consecutive patients with TBI identified by neuroimaging were registered. The admission rate of TBI of all severities has been stable year-round since 2015. Mean age was 52 years (standard deviation 25, range 0-99), and 68% were males. Comorbidities were common; 28% with pre-injury ASA score of ≥3 and 25% used antithrombotic medication. The dominating cause of injury in all ages was falls (55%) but increased with age. Upon admission, the head injury was classified as mild TBI in 46%, moderate in 28%, and severe (Glasgow coma score ≤ 8) in 26%. Case load was stable without seasonal variation. Majority of patients (68%) were admitted during evening, night or weekend. 68% was admitted to intensive care unit. Length of hospital stay was 4 days (median, interquartile range 3-9). 30-day survival for mild, moderate and severe TBI was 98, 94 and 69%, respectively. Conclusions: The typical TBI patients admitted to hospital with abnormal neuroimaging were aged 50-79 years, often with significant comorbidity, and admitted outside ordinary working hours. This suggests the necessity for allhour presence of competent health care professionals.

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“…The EMR-ISS is a validated tool/method to measure injury severity using the International Statistical Classification of Diseases and Related Health Problems 10th Revision, Clinical Modification (ICD-10-CM) [18]. The EMR-ISS score is classified into the following four levels of injury severity: Mild (1-9), moderate (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), severe (25-74), and critical (≥75 or death). For the logistic regression analysis, we divided the EMR-ISS score into two groups: mild and moderate (≤25) versus severe and critical (≥25).…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, patients aged over 18 years were included in the study. Specifically, patients were divided into the following four groups by age: Group 1, 18-34 years; Group 2, 35-49 years; Group 3, 50-64 years; and Group 4, ≥65 years [16,23,24].…”

Section: Study Design and Data Collectionmentioning

confidence: 99%

National Surveillance of Injury in the Republic of Korea: Increased Injury Vulnerability in the Late Middle Age

Chang

Min

Yoo

et al. 2021

IJERPH

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Surveillance of injury patterns and comparisons among different age groups help develop a better understanding of recent injury trends and early prevention. This study conducted a national surveillance of injury by age group. Data were collected retrospectively from Emergency Department-Based Injury In-Depth Surveillance (EDIIS) in South Korea, between January 2011 and December 2017. Patients were divided into the following four groups by age: Group 1–18 to 34 years, Group 2–35 to 49 years, Group 3–50 to 64 years, and Group 4—≥65 years. A total of 1,221,746 patients were included in the study. Findings revealed that, each year, the injury rate increased in the population aged ≥65 years. The place and mechanism of injury in Group 3 were similar to those in younger age groups, while injury outcomes and injured body parts were similar to those in Group 4. Further, hospital admission rate, ICU admission rate, hospital death, traumatic brain injury, and injury severity increased with an increase in age. In our study, each age group showed diverse characteristics pertaining to the mechanism, place, time, and outcomes of injuries. Interestingly, Group 3, which represented the late middle age, exhibited increased vulnerability to injury, and emerged as a gray zone between the young and old age groups. Therefore, different injury prevention methods are needed for each age group. Specifically, early prevention methods need to be implemented from the late middle age to improve the old age group’s injury outcomes.

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Injury patterns and outcomes in late middle age (55–65): The intersecting comorbidity with high-risk activity – A retrospective cohort study

Cited by 8 publications

References 19 publications

Redefining geriatric trauma: 55 is the new 65

Redefining geriatric trauma: 55 is the new 65

Characteristics of traumatic brain injury patients with abnormal neuroimaging in Southeast Norway

National Surveillance of Injury in the Republic of Korea: Increased Injury Vulnerability in the Late Middle Age

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