An appraisal of trauma in the elderly
To review the trends of trauma in the elderly experienced at our trauma center compared with other Level I trauma centers. This was a retrospective trauma registry analysis (1996-2003) of 2783 blunt trauma in elderly (BTE) and 4568 adult (BTA) patients in a Level 1 trauma center. Falls and motor veh...
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| Veröffentlicht in: | The American surgeon 2007-04, Vol.73 (4), p.354-358 |
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| creator | SHARMA, Om P OSWANSKI, Michael F SHARMA, Vijay STRINGFELLOW, Kathryn RAJ, Shekhar S |
| description | To review the trends of trauma in the elderly experienced at our trauma center compared with other Level I trauma centers. This was a retrospective trauma registry analysis (1996-2003) of 2783 blunt trauma in elderly (BTE) and 4568 adult (BTA) patients in a Level 1 trauma center. Falls and motor vehicular crashes were the most common mechanisms noted in 47 per cent and 31 per cent (84% and 13% in BTE, 25% and 42% in BTA). BTE were sicker, with higher Injury Severity Scores (ISS), lengths of stay, and mortality (5% vs 2%, P value < 0.05). ISS was 5.2-fold higher in nonsurvivors to survivors in BTA and 2.4-fold in BTE. Elevation in ISS resulted in higher linear increase in mortality in BTE (vs BTA) at any ISS level. Mortality in patients with ISS > or = 25 was 43.5 per cent vs 23.8 per cent. ISS > or = 50 had 31 per cent adult survivors but no elderly survivors. Among isolated injuries, head trauma in the elderly carried the highest mortality, at 12 per cent (19% in patients with an Abbreviated Injury Score > or = 3). Abdominal injuries were the most lethal (18.3% and 41.2% in patients with an Abbreviated Injury Score > or = 3) in multiple trauma victims (41% vs 18% in isolated trauma). There was 4.4-fold increased mortality in the presence of thoracic trauma. Combined head, chest, and abdominal trauma carried the worst prognosis. Thirty-four per cent of BTE and 88 per cent of BTA patients were discharged home. Elderly patients need more aggressive therapy, as they are sicker with higher mortality. |
| doi_str_mv | 10.1177/000313480707300409 |
| format | Article |
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This was a retrospective trauma registry analysis (1996-2003) of 2783 blunt trauma in elderly (BTE) and 4568 adult (BTA) patients in a Level 1 trauma center. Falls and motor vehicular crashes were the most common mechanisms noted in 47 per cent and 31 per cent (84% and 13% in BTE, 25% and 42% in BTA). BTE were sicker, with higher Injury Severity Scores (ISS), lengths of stay, and mortality (5% vs 2%, P value < 0.05). ISS was 5.2-fold higher in nonsurvivors to survivors in BTA and 2.4-fold in BTE. Elevation in ISS resulted in higher linear increase in mortality in BTE (vs BTA) at any ISS level. Mortality in patients with ISS > or = 25 was 43.5 per cent vs 23.8 per cent. ISS > or = 50 had 31 per cent adult survivors but no elderly survivors. Among isolated injuries, head trauma in the elderly carried the highest mortality, at 12 per cent (19% in patients with an Abbreviated Injury Score > or = 3). Abdominal injuries were the most lethal (18.3% and 41.2% in patients with an Abbreviated Injury Score > or = 3) in multiple trauma victims (41% vs 18% in isolated trauma). There was 4.4-fold increased mortality in the presence of thoracic trauma. Combined head, chest, and abdominal trauma carried the worst prognosis. Thirty-four per cent of BTE and 88 per cent of BTA patients were discharged home. Elderly patients need more aggressive therapy, as they are sicker with higher mortality.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313480707300409</identifier><identifier>PMID: 17439028</identifier><identifier>CODEN: AMSUAW</identifier><language>eng</language><publisher>Atlanta, GA: Southeastern Surgical Congress</publisher><subject>Abdominal Injuries ; Accidental Falls - statistics & numerical data ; Accidents, Traffic - statistics & numerical data ; Adolescent ; Adult ; Adults ; Aged ; Biological and medical sciences ; Craniocerebral Trauma - epidemiology ; Death & dying ; General aspects ; Head injuries ; Hospitals ; Humans ; Injury Severity Score ; Medical sciences ; Middle Aged ; Mortality ; Motorcycles ; Nursing homes ; Ohio - epidemiology ; Patients ; Prognosis ; Retrospective Studies ; Standard deviation ; Thoracic Injuries - epidemiology ; Trauma ; Wounds and Injuries - epidemiology</subject><ispartof>The American surgeon, 2007-04, Vol.73 (4), p.354-358</ispartof><rights>2007 INIST-CNRS</rights><rights>Copyright Southeastern Surgical Congress Apr 2007</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c402t-7b1b54cb39ab72a66568b9efa94deb177455fd6f78f5c91bd824a3b9643c60bf3</citedby><cites>FETCH-LOGICAL-c402t-7b1b54cb39ab72a66568b9efa94deb177455fd6f78f5c91bd824a3b9643c60bf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18665067$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17439028$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SHARMA, Om P</creatorcontrib><creatorcontrib>OSWANSKI, Michael F</creatorcontrib><creatorcontrib>SHARMA, Vijay</creatorcontrib><creatorcontrib>STRINGFELLOW, Kathryn</creatorcontrib><creatorcontrib>RAJ, Shekhar S</creatorcontrib><title>An appraisal of trauma in the elderly</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>To review the trends of trauma in the elderly experienced at our trauma center compared with other Level I trauma centers. This was a retrospective trauma registry analysis (1996-2003) of 2783 blunt trauma in elderly (BTE) and 4568 adult (BTA) patients in a Level 1 trauma center. Falls and motor vehicular crashes were the most common mechanisms noted in 47 per cent and 31 per cent (84% and 13% in BTE, 25% and 42% in BTA). BTE were sicker, with higher Injury Severity Scores (ISS), lengths of stay, and mortality (5% vs 2%, P value < 0.05). ISS was 5.2-fold higher in nonsurvivors to survivors in BTA and 2.4-fold in BTE. Elevation in ISS resulted in higher linear increase in mortality in BTE (vs BTA) at any ISS level. Mortality in patients with ISS > or = 25 was 43.5 per cent vs 23.8 per cent. ISS > or = 50 had 31 per cent adult survivors but no elderly survivors. Among isolated injuries, head trauma in the elderly carried the highest mortality, at 12 per cent (19% in patients with an Abbreviated Injury Score > or = 3). Abdominal injuries were the most lethal (18.3% and 41.2% in patients with an Abbreviated Injury Score > or = 3) in multiple trauma victims (41% vs 18% in isolated trauma). There was 4.4-fold increased mortality in the presence of thoracic trauma. Combined head, chest, and abdominal trauma carried the worst prognosis. Thirty-four per cent of BTE and 88 per cent of BTA patients were discharged home. Elderly patients need more aggressive therapy, as they are sicker with higher mortality.</description><subject>Abdominal Injuries</subject><subject>Accidental Falls - statistics & numerical data</subject><subject>Accidents, Traffic - statistics & numerical data</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Adults</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Craniocerebral Trauma - epidemiology</subject><subject>Death & dying</subject><subject>General aspects</subject><subject>Head injuries</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Motorcycles</subject><subject>Nursing homes</subject><subject>Ohio - epidemiology</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Standard deviation</subject><subject>Thoracic Injuries - 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statistics & numerical data</topic><topic>Accidents, Traffic - statistics & numerical data</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Adults</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Craniocerebral Trauma - epidemiology</topic><topic>Death & dying</topic><topic>General aspects</topic><topic>Head injuries</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Motorcycles</topic><topic>Nursing homes</topic><topic>Ohio - epidemiology</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Standard deviation</topic><topic>Thoracic Injuries - epidemiology</topic><topic>Trauma</topic><topic>Wounds and Injuries - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SHARMA, Om P</creatorcontrib><creatorcontrib>OSWANSKI, Michael F</creatorcontrib><creatorcontrib>SHARMA, Vijay</creatorcontrib><creatorcontrib>STRINGFELLOW, Kathryn</creatorcontrib><creatorcontrib>RAJ, Shekhar S</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SHARMA, Om P</au><au>OSWANSKI, Michael F</au><au>SHARMA, Vijay</au><au>STRINGFELLOW, Kathryn</au><au>RAJ, Shekhar S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An appraisal of trauma in the elderly</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2007-04-01</date><risdate>2007</risdate><volume>73</volume><issue>4</issue><spage>354</spage><epage>358</epage><pages>354-358</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><coden>AMSUAW</coden><abstract>To review the trends of trauma in the elderly experienced at our trauma center compared with other Level I trauma centers. This was a retrospective trauma registry analysis (1996-2003) of 2783 blunt trauma in elderly (BTE) and 4568 adult (BTA) patients in a Level 1 trauma center. Falls and motor vehicular crashes were the most common mechanisms noted in 47 per cent and 31 per cent (84% and 13% in BTE, 25% and 42% in BTA). BTE were sicker, with higher Injury Severity Scores (ISS), lengths of stay, and mortality (5% vs 2%, P value < 0.05). ISS was 5.2-fold higher in nonsurvivors to survivors in BTA and 2.4-fold in BTE. Elevation in ISS resulted in higher linear increase in mortality in BTE (vs BTA) at any ISS level. Mortality in patients with ISS > or = 25 was 43.5 per cent vs 23.8 per cent. ISS > or = 50 had 31 per cent adult survivors but no elderly survivors. Among isolated injuries, head trauma in the elderly carried the highest mortality, at 12 per cent (19% in patients with an Abbreviated Injury Score > or = 3). Abdominal injuries were the most lethal (18.3% and 41.2% in patients with an Abbreviated Injury Score > or = 3) in multiple trauma victims (41% vs 18% in isolated trauma). There was 4.4-fold increased mortality in the presence of thoracic trauma. Combined head, chest, and abdominal trauma carried the worst prognosis. Thirty-four per cent of BTE and 88 per cent of BTA patients were discharged home. Elderly patients need more aggressive therapy, as they are sicker with higher mortality.</abstract><cop>Atlanta, GA</cop><pub>Southeastern Surgical Congress</pub><pmid>17439028</pmid><doi>10.1177/000313480707300409</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Abdominal Injuries Accidental Falls - statistics & numerical data Accidents, Traffic - statistics & numerical data Adolescent Adult Adults Aged Biological and medical sciences Craniocerebral Trauma - epidemiology Death & dying General aspects Head injuries Hospitals Humans Injury Severity Score Medical sciences Middle Aged Mortality Motorcycles Nursing homes Ohio - epidemiology Patients Prognosis Retrospective Studies Standard deviation Thoracic Injuries - epidemiology Trauma Wounds and Injuries - epidemiology |
| title | An appraisal of trauma in the elderly |
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