The geriatric polytrauma: Risk profile and prognostic factors

Rupprecht, Holger; Heppner, Hans Jürgen; Wohlfart, Kristina; Turkoglu, Alp

doi:10.5505/tjtes.2016.77177

Cited by 16 publications

(21 citation statements)

References 43 publications

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“…Although blood transfusion may indicate an important physiological response to a drop of systolic blood pressure or a risk associated with penetration injury, the use of BT as the sole physiological variable may not be accurate as that calculated from RTS, which is made up of three categories: Glasgow Coma Scale (GCS), systolic blood pressure, and respiratory rate [ 17 ]. A very low GCS score, a variable that is not used in the calculation of GTOS, is a strong clinical indicator of prognosis in patients with traumatic brain injury [ 18 ]. Patients with a GCS score below 12 was associated with a twofold increase in mortality rate (39% vs 83%) compared with those who had a GCS score equal or higher than 12 [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…A very low GCS score, a variable that is not used in the calculation of GTOS, is a strong clinical indicator of prognosis in patients with traumatic brain injury [ 18 ]. Patients with a GCS score below 12 was associated with a twofold increase in mortality rate (39% vs 83%) compared with those who had a GCS score equal or higher than 12 [ 18 ]. Furthermore, the units of blood transfused may indicate profound hemorrhage shock.…”

Section: Discussionmentioning

confidence: 99%

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Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Rau

Kuo

et al. 2018

IJERPH

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Background: For elderly trauma patients, a prognostic tool called the Geriatric Trauma Outcome Score (GTOS), where GTOS = (age) + (ISS × 2.5) + (22 if any packed red blood cells (pRBCs) were transfused within 24 h after admission), was developed for predicting mortality. In such calculation, a score of 22 was added in the calculation of GTOS regardless of the transfused units of blood. This study aimed to assess the effect of transfused blood units on the mortality outcomes of the elderly trauma patients who received blood transfusion (BT). Methods: Detailed data of 687 elderly trauma patients aged ≥65 years who were transfused with pRBCs within 24 h after admission into a level I trauma center between 1 January 2009 and 31 December 2016 were retrieved from the Trauma Registry System database. Based on the units of pRBCs transfused, the study population was divided into two groups to compare the mortality outcomes between these groups. Adjusted odds ratios (AORs) with its 95% confidence intervals (CIs) for mortality were calculated by adjusting sex, pre-existing comorbidities, and GTOS. Results: When the cut-off value of BT was set as 3 U of pRBCs, patients who received BT ≥ 3 U had higher odds of mortality than those who received BT < 3 U (OR, 3.0; 95% CI, 1.94–4.56; p < 0.001). Patients who received more units of pRBCs still showed higher odds of mortality than their counterparts. After adjusting for sex, pre-existing comorbidities, and GTOS, comparison revealed that the patients who received BT of 3 U to 6 U had a 1.7-fold adjusted odds of mortality than their counterparts. The patients who received BT ≥ 8 U and 10 U had a 2.1-fold (AOR, 2.1; 95% CI, 1.09–3.96; p < 0.001) and 4.4-fold (AOR, 4.4; 95% CI, 2.04–9.48; p < 0.001) adjusted odds of mortality than those who received BT < 8 U and <10 U, respectively. Conclusions: This study revealed that the units of BT did matter in determining the probability of mortality. For those who received more units of blood, the mortality may be underestimated according to the GTOS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Rau

Kuo

et al. 2018

IJERPH

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“…Anti-platelet therapy, NACA score, initial GCS, ISS and age were risk factors for mortality. Several previous studies [7,18,[22][23][24][25][26][31][32][33] have described advanced age, along with higher ISS and lower GCS as being associated with trauma mortality.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Geriatric Major Trauma Patients Admitted in the Shock Room of a Swiss Academic Hospital: Characteristics and Prognosis

Pagin

Mabire

Cotton

et al. 2020

JCM

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Increased life expectancy exposes a great number of elderly people to serious accidents, thus increasing the amount of major geriatric trauma cases. The aim of our study was to determine the profile of elderly patients undergoing major trauma, and the contributing factors predicting mortality in this specific patient group, compared to the younger population. Retrospective analysis of 1051 patients with major trauma admitted over ten years in a Level-1 trauma center was performed. Data collected were: history, nature and type of trauma; age and sex; vital signs on admission; injury severity score; shock index; comorbidities; coagulation diathesis; injury patterns; emergency measures taken; main diagnosis; mortality; and length of hospital and intensive care unit (ICU) stay. Geriatric patients admitted for major trauma have a mortality rate almost four times greater (47%) than their younger counterparts (14%) with the same ISS. According to statistical regression analysis, anti-platelet therapy (OR 3.21), NACA (National Advisory Committee for Aeronautics) score (OR 2.23), GCS (OR 0.83), ISS (OR 1.07) and age (OR 1.06) are the main factors predicting mortality. Conclusion: Geriatric major trauma patients admitted to our trauma resuscitation area have a high mortality rate. Age, GCS, ISS and NACA scores as well as anti-platelet therapy are the main factors predicting mortality.

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“…Most studies de ned geriatric trauma patients as patients over the age of 65 years [11] .Due to geriatric patients generally decreased physiological reserves and suffered from underlying diseases,they were more susceptible for high mortality rate and fatal complications, particularly MODS [12] .Alteration in the cardiovascular and respiratory systems exacerbated the potential to hypoxia and shock,pre-existing conditions of the respiratory system increased the risk for pneumonia,as well as acute respiratory distress syndrome(ARDS) [11] .Despite the severity of the injury is equivalent,geriatric patients have worse outcome than younger patients [13] .A study reported by Aldrian showed that elderly patients with multiple trauma had a signi cantly higher incidence of MODS compared to younger group(17.8% vs 7.1%,p=0.02) [14] .Similarly,in our study the ratio of geriatric patients (age over 65 years) in MODS group had a signi cance higher than non-MODS group(31.7% vs 20.7%,p=0.009).…”

Section: Discussionmentioning

confidence: 99%

A Nomogram Based on Clinical Characteristics for Predicting Multiple Organ Dysfunction Syndrome(MODS) Following Multiple Trauma Patients

Miao

Wei

Zhou

2020

Preprint

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BackgroundMultiple organ dysfunction syndrome (MODS) is the one of common complications,and the leading cause of late mortality in multiple trauma patients.The present study aims to develop and validate a nomogram based on clinical characteristics in order to identify the patients with multiple trauma who were at risk of developing MODS.MethodsAn retrospective cohort study was performed with data from January 2011 to December 2019,totally 770 patients with multiple trauma were enrolled in our study.They were randomly categorized into training set (n=514) and validation set (n=256).The univariate and multivariate logistic regression analyses were used to screen the predictors for multiple trauma patients who were at risk of developing MODS from training set data.Then we established a nomogram based on these above predictors.The discriminative capacity was assessed by receiver operating characteristic (ROC) curve area under the curve (AUC), and the predictive precision was depicted by calibration plot.The Hosmer-Lemeshow test was used to evaluate the the model’s goodness of fit.ResultsOur study showed that age,ISS,hemorrhagic shock,heart rate,blood glucose,D-dimer and APTT were independent risk factors for MODS in patients with multiple trauma by multivariate logistic regression analysis.A nomogram was established on basis of these above risk factors.The area under the curve (AUC) was 0.868 (95% confidence interval [CI]:0.829-0.908) in the training set and 0.884 (95% confidence interval [CI]:0.833-0.935) in the validation set.The Hosmer-Lemeshow test has a p value of 0.227 in training set and 0.554 in validation set respectively,which confirm the model’s goodness of fit.Calibration plot showed that the predicted and actual incidence of MODS probability were fitted well on both internal and external validations.ConclusionsThe present nomogram had a well predictive precision and discrimination capacity,which can facilitate improved screening and early identification of multiple trauma patients who were at high risk of developing MODS.

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The geriatric polytrauma: Risk profile and prognostic factors

Cited by 16 publications

References 43 publications

Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Retrospective Analysis of Geriatric Major Trauma Patients Admitted in the Shock Room of a Swiss Academic Hospital: Characteristics and Prognosis

A Nomogram Based on Clinical Characteristics for Predicting Multiple Organ Dysfunction Syndrome(MODS) Following Multiple Trauma Patients

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