Polytrauma in the elderly: a review

Abstract

Although the field of geriatric trauma is – ironically – young, care for the elderly trauma patient is increasingly recognised as an important challenge, considering the worldwide trend towards increasing longevity.Increasing age is associated with physiological changes and resulting comorbidities that present multiple challenges to the treating physician.Even though polytrauma is less likely with increasing age, lower-energy trauma can also result in life-threatening injuries due to the reduced physiological reserve.Mechanisms of injury and resulting injury patterns are markedly changed in the elderly population and new management strategies are needed. From initial triage to long-term rehabilitation, these patients require care that differs from the everyday standard.In the current review, the special requirements of this increasing patient population are reviewed and management options discussed. With the increase in orthogeriatrics as a speciality, the current status quo will almost certainly shift towards a more tailored treatment approach for the elderly patient. Further research expanding our current knowledge is needed to reduce the high morbidity and mortality rate.Cite this article: Braun BJ, Holstein J, Fritz T, Veith NT, Herath S, Mörsdorf P, Pohlemann T. Polytrauma in the elderly: a review. EFORT Open Rev 2016;1:146-151. DOI: 10.1302/2058-5241.1.160002.

In‐hospital mortality of pelvic ring fractures in older adults now and then: A pelvic registry study

“…Currently, there is a huge gap in medicinal research regarding older adults and the constantly increasing demand of medical solutions and resources for this very vulnerable age group. In particular, research on geriatric traumatology is currently not meeting the high demand …”

“…In particular, research on geriatric traumatology is currently not meeting the high demand. 15 Patients suffering from pelvic ring fractures have a lower quality of life when compared with population norms; hereby age has been recognized as an independent negative predictor influencing quality of life after pelvic ring fractures. 13 Because the research on pelvic ring fractures in older adults still remains a fairly underrepresented field in trauma research, we herein analyzed the data of 5665 patients aged ≥60 years included in the German Pelvic Trauma Registry.…”

Risk factors for death of trauma patients admitted to an Intensive Care Unit

“…Vasoactive drugs may be transiently required in the presence of life-threatening hypotension (34) and early use may limit organ hypoperfusion and prevent multiple failure (28) . However, evidence identified in a systematic review of the early use of vasopressors after traumatic injury highlights that, in addition to the benefits, some damage from vasopressor therapy in the early phase of trauma is also reported, such as the risk of bleeding, coagulopathy, compartment syndrome, and surgical complications (34) .…”

“…the elderly often experience progressive loss of mass and skeletal muscle strength(26) , as shown by research that analyzed the body composition of elderly in French ICU by computed tomography and identified loss of skeletal muscles and adipose tissue, being higher in those with infections(27) . Other pathophysiological conditions of the elderly, such as the reduction of endogenous catecholamines, which limits the response to hemorrhage, the reduction of kidney functional reserve by up to 40% of the glomeruli, and the reduction of lung, bone and immunological functions(28) may impact survival of the elderly with trauma. This propensity to physiological deterioration makes the traumatized elderly one of the most vulnerable population groups and, therefore, in their admission to the ICU, this characteristic should be considered in the care provided.…”

Erythropoietin in the Evaluation of Treatment Outcomes in Patients with Polytrauma

“…Treatment of patients with polytrauma requires plenty of resources and eff ort, multiple surgeries, prolonged stay at intensive care unit, and complex rehabilitation programs 1,2,7 . Mortality in patients with polytrauma varies from 9% to 48%, depending on age group, extent of injuries, other comorbidities, and appropriate triage 5,6,[8][9][10] .…”