Major trauma in geriatric patients.

Champion, Howard R.; Copes, Wayne S.; Buyer, Douglas M.; Flanagan, Mindy E.; Bain, Lawrence W.; Sacco, William J.

doi:10.2105/ajph.79.9.1278

Cited by 256 publications

(132 citation statements)

References 15 publications

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“…The mortality of patients ‡ 55 years of age was 35% in contrast to a mortality of 20% of patients < 55 years of age. This difference is in accordance with previous studies [2][3][4][5] and confirm the belief that geriatric trauma patients necessitate prompt and aggressive management [6][7][8].…”

Section: Introductionsupporting

confidence: 93%

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

Nijboer

Sluis

Dijkstra

et al. 2008

Eur J Trauma Emerg Surg

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The value of the trauma mechanism in the triage of severely injured elderly Nijboer, J.M.M.; van der Sluis, Corry K.; Dijkstra, Pieter U. ; ten Duis, H.J. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Abstract Background: The triage of trauma patients is currently based on the trauma mechanism. However, it is known that elderly patients can sustain severe injuries due to insignificant trauma mechanisms. As such, triage methods might be questionable. Objective: To evaluate whether current trauma triage criteria are appropriate in severely injured elderly patients. Methods: To analyze the effect of the trauma mechanism on triage and treatment, consecutive patients ‡ 55 years of age, with an injury severity score > 15, treated from 2002 to 2005 were divided into those who sustained a high-energy trauma (HET) versus a low energy trauma (LET). Pre-hospital and in-hospital data, injury characteristics, and data on mortality and disablement one year postinjury (sickness impact profile) were analyzed for HET and LET groups. Results: Age, sex and co-morbidity rate were similar in 84 HET patients and 107 LET patients. HET patients (mean ISS 28) received more sophisticated trauma care than LET patients (mean ISS 22), although mortality was similar (38 vs. 34%). Long-term disablement was also similar (median SIP scores 4 vs. 6). Severe head injuries and the Revised Trauma Score were related to mortality. Physical disablement was related to preexisting co-morbidities. No variables were related to psychosocial disablement. Conclusions: In elderly people a low energy trauma may lead to severe consequences. Not only the trauma mechanism, but also age, co-morbidity, and the likelihood of a brain injury should be leading in the triage and subsequent management of severely injured elderly.

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Section: Introductionsupporting

confidence: 93%

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

Nijboer

Sluis

Dijkstra

et al. 2008

Eur J Trauma Emerg Surg

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Section: Introductionmentioning

confidence: 99%

“…1 They are more likely to be injured in a given incident, the injuries they sustain are more severe, and their injuries are more difficult to diagnose. 1 In addition, older patients have more chronic comorbid conditions, they are more likely to suffer complications, and they are more likely to die from their injuries. 1 Their ability to recuperate is reduced, they respond differently to treatment, longterm functional outcomes are as yet undetermined, and their treatment is more expensive, when compared with the younger population.…”

Section: Introductionmentioning

confidence: 99%

“…1 In addition, older patients have more chronic comorbid conditions, they are more likely to suffer complications, and they are more likely to die from their injuries. 1 Their ability to recuperate is reduced, they respond differently to treatment, longterm functional outcomes are as yet undetermined, and their treatment is more expensive, when compared with the younger population. 1,2 The effectiveness of regionalized trauma care systems and aggressive trauma center (TC) treatment protocols in meeting the needs of the older population has not been fully evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Geriatric Trauma Patients—Are They Receiving Trauma Center Care?

Lane

Sorondo

Kelly

2003

Academic Emergency Medicine

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Objectives: The primary purpose of this study was to evaluate whether severely injured geriatric patients were as likely to be treated at designated trauma centers (TCs) within the statewide trauma system. The secondary objective was to compare the demographic and injury characteristics of severely injured older and young patients who received care in TCs with the characteristics of those patients cared for in non-TCs. Methods: The authors reviewed files for all acute injury discharges in Pennsylvania for 1997. Injury diagnoses were mapped to Abbreviated Injury Scale (AIS) scores using ICDMAP software; the Injury Severity Score (ISS) was computed. The frequency of hospital discharges for injury from TC and non-TC hospitals in both the older (E) ($65 years) and younger (Y) (,65 years) groups were computed, and compared using chisquare testing for significance. Logistic regression was performed to assess the influence of various factors. Severity of injury was controlled for with both ISS and Maximum AIS (MAIS). Results: 107,358 patients were admitted to hospitals in the state because of injury; 8,980 had an ISS . 15; 5,855 were Y and 3,125 were E. Forty-seven percent of the Y patients received TC care compared with only 36.6% of the E patients (p , 0.001). Logistic regression analysis showed that age was a strongly negative predictor for TC care when injury severity was controlled. Conclusions: Seriously injured older patients were less likely to receive care in a trauma center than younger patients.

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“…3 Compared to younger trauma victims, older individuals have a greater fatality rate, longer length of hospit alization, greater frequency of complica tions, and greater costs of care.4-1O Despite these figures, most trauma research has focused on injury in the young. 9 One of the most serious of all trauma types, spinal cord injury (SCI), has tradi tionally been identified as a condition of youth. However, as many as 20% of .…”

Section: Introductionmentioning

confidence: 99%

The older adult with a spinal cord injury

et al. 1992

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Sixty-two consecutive acute spinal cord injury (SCI) patients who were aged 55 years or older were studied and compared to 296 SCI patients of age less than 55 years. Compared to younger patients, the older group had significantly more females (29%), preexisting medical conditions (87%), associated injuries (55%), incomplete quadriplegic patients (63%), and persons whose injuries resulted from falls (53%). There were no differences between groups in frequency of ventilator use, occurrence of medical complications, or acute length of stay, but older patients tended to have fewer surgical spinal fusions (40%), shorter rehabilitation stays (66.5 days), more indwelling urethral cathteters (31%), and more nursing home discharges (19%). With other factors being controlled, advancing age was predictive only of nursing home discharge, and not of acute or rehabilitation lengths of stay. Among older SCI patients, those with complete injuries were nearly 3 times as likely to have been discharged to nursing homes in our series compared to older patients with incomplete lesions. Although many aspects of the presentation, course, and care of older SCI individuals are similar to those of younger patients, there are several unique features of older adults with a SCI.

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Major trauma in geriatric patients.

Cited by 256 publications

References 15 publications

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

Geriatric Trauma Patients—Are They Receiving Trauma Center Care?

The older adult with a spinal cord injury

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