Major trauma in the older patient: Evolving trauma care beyond management of bumps and bruises

Carpenter, Christopher R.; Arendts, Glenn; Hullick, Carolyn; Nagaraj, Guruprasad; Cooper, Zara; Burkett, Ellen

doi:10.1111/1742-6723.12785

Cited by 11 publications

(6 citation statements)

References 69 publications

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“…24 Incorrect inferences surrounding physiological changes and baseline parameters, particularly with older adult sepsis and trauma patients, are common pitfalls as atypical underlying physiological substrate and lack of 'textbook' presentations are often not within 'normal' parameters. 22,25,26 Hobson's 27 perspective as a geriatrician covers a variety of topics to improve trainee interactions, investigation rationalisation and management plans with respect to older adult care in the ED.…”

Section: Gem Masterclassmentioning

confidence: 99%

Geriatric emergency medicine: Complexity evolves with age

Colalillo

2023

Emerg Medicine Australasia

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Section: Gem Masterclassmentioning

confidence: 99%

Geriatric emergency medicine: Complexity evolves with age

Colalillo

2023

Emerg Medicine Australasia

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“…Head injuries, which account for nearly half of fall deaths, most commonly from subdural hematoma . Intracranial haemorrhage deaths predominate in anticoagulated fall victims, so computed tomography imaging in these patients is appropriate if they present to the ED. Rib fractures, with mortality associated with increasing age, increasing number of ribs fractured and underlying cardiac problems …”

Section: Fall Injuries and Consequencesmentioning

confidence: 99%

“…The ED management of geriatric major trauma injuries was previously reviewed in this series and is the same for fall victims …”

Section: Fall Injuries and Consequencesmentioning

confidence: 99%

Avoiding anchoring bias by moving beyond ‘mechanical falls’ in geriatric emergency medicine

Nagaraj

Hullick

Arendts

et al. 2018

Emerg Medicine Australasia

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“…4 These patients are jeopardized by underestimation of the trauma mechanism and by lack of early identification of potentially severe injuries during the course of clinical management. 6 Liberal use of pan-scan CT for injury detection in older trauma patients has been recommended, 7 but there is still a paucity of evidence to support this. Evidence regarding imaging strategies in older patients with LEF is even scarcer.…”

Section: Introductionmentioning

confidence: 99%

“…Liberal use of pan-scan CT for injury detection in older trauma patients has been recommended, 7 but there is still a paucity of evidence to support this. Evidence regarding imaging strategies in older patients with LEF is even scarcer.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of plain radiography in detecting fractures in older individuals after low-energy falls: current evidence

Pedersen

Lampart

Bingisser

et al. 2020

Trauma Surg Acute Care Open

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BackgroundOlder individuals sustaining low-energy falls (LEF) and presenting to the emergency department (ED) demand straightforward diagnostic measures for injury detection. Plain radiography (XR) series for diagnosis of fall-related injuries are standard of care, but frequently subsequent CT examination is required for diagnostic assurance. A systematic database search of diagnostic accuracy of XR for detection of fractures in older LEF patients was performed.MethodsWe searched PubMed, Embase, Cochrane Library, WHO International Clinical Trial Platform, and Clinical trials.gov databases from inception to January 2020 for studies including older patients (≥65 years) with LEF and obtaining CT examination and XR of the skeleton in an ED setting.ResultsFrom 8944 references screened, 11 studies met the criteria for inclusion. Performance of XR for detection of fractures of the pelvic ring and hip was analyzed in nine studies, two studies investigated XR performance to detect rib fractures, and two studies compared diagnostic accuracy of thoracolumbar spine XR. Sensitivity estimates ranged from 10% to 58% and specificity estimates from 55% to 100%. Clinical and statistical heterogeneity was significant among included studies, with an overall considerable risk of bias.DiscussionHigh-quality evidence on accurate imaging strategies in older patients with LEF is lacking to date. XR is missing a reasonable amount of fractures of the pelvic ring, rib cage, and thoracic and lumbar spine. However, the utility of first-line CT imaging and the benefit of diagnosing every fracture is unknown, demanding high-quality prospective trials considering patient-oriented outcome as well.

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Major trauma in the older patient: Evolving trauma care beyond management of bumps and bruises

Cited by 11 publications

References 69 publications

Geriatric emergency medicine: Complexity evolves with age

Geriatric emergency medicine: Complexity evolves with age

Avoiding anchoring bias by moving beyond ‘mechanical falls’ in geriatric emergency medicine

Accuracy of plain radiography in detecting fractures in older individuals after low-energy falls: current evidence

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