Practice Management Guidelines for Geriatric Trauma: The EAST Practice Management Guidelines Work Group

Jacobs, David; Plaisier, Brian R.; Barie, Philip S.; Hammond, Jeffrey; Holevar, Michele R.; Sinclair, Karlene E.; Scalea, Thomas M.; Wahl, Wendy L.

doi:10.1097/01.ta.0000042015.54022.be

Cited by 229 publications

(176 citation statements)

References 53 publications

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“…Jacobs et al [29] suggested that advanced patient age itself is not predictive of poor outcomes after trauma. The presence of pre-existing co-morbidities adversely affected outcome, implying that the focus should not be on chronological age but on physiological age.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Such an approach can appear in under-triage to larger centers, withheld or withdrawal of care, or simply by noncompliance with guidelines and/or extreme shift in age-related mortality figures [26][27][28][29]. This is particularly true for countries and health care systems harboring limited resources (vide infra).…”

Section: The Price Of Extended Lifespanmentioning

confidence: 99%

Geriatric Traumatic Brain Injury in Hungary and Eastern Europe

Büki

Czeiter

Kovács

et al. 2012

Curr Tran Geriatr Gerontol Rep

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While the incidence of traumatic brain injury (TBI) is decreasing in the young, active population, injuries are getting more frequent among the elderly; as the geriatric population is in a constant rise and the relative cost of care is particularly high in this group of patients, the economic burden of TBI does not decline. This review is aimed to identify predisposing factors and characteristic features of geriatric brain injury, primarily focusing on the comparison between Eastern and Western European countries. While economically each of these is a high-or middle-income country, the differences in mortality and morbidity, approaches, and policies applied by health care providers are substantial. On the basis of the disappointing outcome results in Eastern Europe, one may conclude that therapeutic guidelines defined on the basis of the "Western experience" should only be applied in conjunction with a systematic reorganization of health care in Eastern Europe.

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“…22,23 Some studies even indicate an increase in mortality from the 4th decade of life onwards. 12,24,25 In this study, the mean age of patients who did not survive was significantly different than patients who survived (55.2 and 36.7 years respectively).…”

Section: Discussionmentioning

confidence: 99%

Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems

Razente¹,

Alvarez²,

Lacerda³

et al. 2017

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Background: This study aims to compare mortality prediction capabilities of three different physiological trauma scoring systems (TSS): Revised Trauma Score (RTS); Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP); and Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP).Study design: A descriptive, cross-sectional study of trauma victims admitted to the emergency service between December-2013 and February-2014. Clinical and epidemiological information were gathered at admission and three TSS were calculated: RTS, GAP, and MGAP. The follow-up period to assess length of hospitalization and mortality lasted until August-2014. Two groups were created -survivals (S) and deaths (D) -and compared. P < 0.05 was considered statistically significant. Results:A total of 668 trauma victims were analyzed. The mean age was 37 ± 18 and 69.8% were males. Blunt trauma prevailed (90.6%). The mean scores of RTS, GAP, and MGAP for group S (n = 657; 98.4%) were 7.77 ± 0.33, 22.8 ± 1.7, and 27.4 ± 2.3 respectively (p < 0.001), whereas group D (n = 11, 1.6%) achieved mean scores of 4.57 ± 2.95, 13 ± 7, and 15.5 ± 7 (p < 0.001). Regarding the Receiver Operating Characteristics (ROC) analysis, the areas under the curve were 0.926 (RTS), 0.941 (GAP), and 0.981 (MGAP). The three TSS demonstrated significant mortality prediction capabilities (p < 0.001). There was no statistically significant difference between the three ROC curves (p = 0.138). The MGAP achieved the highest sensitivity (100%), while GAP and RTS sensitivities were 81.8% (59-100%), and 90.9% (73.9-100%) respectively (p < 0.001). The observed specificities were 96.2% (94.77-97.7%) for GAP, 91.6% (89.5-93.7%) for MGAP, and 87.2% (84.7-89.8%) for RTS (p < 0.001). Age (p = 0.049), Glasgow Coma Scale (GCS) (p < 0.001), and trauma mechanism (p < 0.001) were different between the two groups. Conclusion:Most patients were young males and victims of blunt trauma. The three TSS demonstrated reliability regarding mortality prediction. The MGAP achieved the highest sensitivity and GAP was the most specific score, which may indicate a potential use of both as valuable alternatives to RTS. Keywords:Cross-sectional studies, Emergency medical services, Glasgow coma scale, Hospitalization, Mortality, Receiver operating characteristics curve, Sensitivity and specificity, Trauma severity indices, Triage. Resultados: Analisaram-se 668 vítimas de trauma. Registrou-se média de idade de 37±18 anos, 69,8% sendo masculinos. Predominou o trauma contuso (90,6%). Para o grupo S (n = 657; 98,4%), as médias de RTS, GAP e MGAP foram, respectivamente, 7,77 ± 0,33, 22,8 ± 1,7 e 27,4 ± 2,3 (p < 0,001), enquanto o grupo O (n = 11, 1,6%) obteve médias de 4,57 ± 2,95, 13 ± 7 e 15,5 ± 7 (p < 0,001). A análise Receiver Operating Characteristics (ROC) revelou áreas abaixo da curva de 0,926 (RTS),

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Practice Management Guidelines for Geriatric Trauma: The EAST Practice Management Guidelines Work Group

Cited by 229 publications

References 53 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 Traumatic Brain Injury in Hungary and Eastern Europe

Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems

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