A Comprehensive Investigation of Comorbidities, Mechanisms, Injury Patterns, and Outcomes in Geriatric Blunt Trauma Patients

2016 ◽  
Vol 82 (11) ◽  
pp. 1055-1062 ◽  
Author(s):  
Carlos V. R. Brown ◽  
Kevin Rix ◽  
Amanda L. Klein ◽  
Brent Ford ◽  
Pedro G. R. Teixeira ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Geriatric Patients ◽  
Injury Severity ◽  
Older Age ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Injury Patterns ◽  
Abbreviated Injury Scale

The geriatric population is growing and trauma providers are often tasked with caring for injuries in the elderly. There is limited information regarding injury patterns in geriatric trauma patients stratified by mechanism of injury. This study intends to investigate the comorbidities, mechanisms, injury patterns, and outcomes in geriatric blunt trauma patients. A retrospective study of the 2012 National Trauma Databank was performed. Adult blunt trauma patients were identified; geriatric (>/=65) patients were compared with younger (<65) patients regarding admission demographics and vital signs, mechanism and severity of injury, and comorbidities. The primary outcome was injuries sustained and secondary outcomes included mortality, length of stay in the intensive care unit and hospital, and ventilator days. There were 589,830 blunt trauma patients who met the inclusion criteria, including 183,209 (31%) geriatric and 406,621 (69%) nongeriatric patients. Falls were more common in geriatric patients (79 vs 29%, P < 0.0001). Geriatric patients less often had an Injury Severity Score >/=16 (18 vs 20%, P < 0.0001) but more often a head Abbreviated Injury Scale >/=3 (24 vs 18%, P < 0.0001) and lower extremity Abbreviated Injury Scale >/=3 (24% vs 8%, P < 0.0001). After logistic regression older age was an independent risk factor for mortality for the overall population and across all mechanisms. Falls are the most common mechanism for geriatric trauma patients. Geriatric patients overall present with a lower Injury Severity Score, but more often sustain severe injuries to the head and lower extremities. Injury patterns vary significantly between older and younger patients when stratified by mechanism. Mortality is significantly higher for geriatric trauma patients and older age is independently associated with mortality across all mechanisms.

scholarly journals Change in Age Distribution of the Injuries and Comparison of Different Scoring Tools in Predicting Mortality Among Geriatric Trauma Patients

2020 ◽  
Author(s):  
Libing Jiang ◽  
Zhongjun Zheng ◽  
Mao Zhang
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Survival Group ◽  
Elderly Trauma Patients ◽  
Scoring Tools ◽  
Death Group

Abstract Purpose: The aim of this study was to describe the age trend of trauma patients and to compare different scoring tools to predict in-hospital mortality in elderly trauma patients.Methods: National Trauma Database (NTDB) in the United States from 2005 to 2015 and the Trauma Register DGU® in German from 1994 to 2012 was searched to describe age change of trauma patients. Then we secondly analyzed the data published in http://datadryad.org/. According to the in-hospital survival status, patients were divided into survival group and non-survival group. Receiver Operating Characteristic Curve (ROC) analysis was used to evaluated the value of ISS (injury severity score); NISS (new injury severity score), APACHE Ⅱ (Acute Physiology and Chronic Health Evaluation Ⅱ), SPAS Ⅱ (simplified acute physiology score Ⅱ) and TRISS (Trauma and Injury Severity Score) in predicting in-hospital mortality among geriatric trauma patients.Results:The analysis of NTDB showed the percentage of geriatric trauma has increased from 0.18 to 0.30, 2005-2015. The analysis of DGU showed the mean age rose from 39.11 in 1993 to 51.10 in 2013, and the percentage of patients aged ≥60 rose from 16.5% to 37.5%. A total of 311 patients aged more than 65 years were secondly analyzed. One hundred and sixty-four (52.73%) patients died in the hospital. ISS, NISS, APACHE, and SAPS in the death group were significantly higher than those in the survival group, but TRISS in the death group was significantly lower than those in the survival group. The AUC of APACHE Ⅱ was 0.715, ISS was 0.807, NISS was 0.850, SPAS Ⅱ was 0.725, and TRISS was 0.828.Conclusion:The increasing number of trauma in the elderly is a challenge for current and future trauma management. Compared with APACHE and SAPS, ISS, NISS and TRISS are more suitable for predicting in-hospital mortality in elderly trauma patients.

scholarly journals Validation of Age-specific Survival Prediction in Pediatric Patients With Blunt Trauma Using Trauma and Injury Severity Score Methodology: A Ten-year Nationwide Observational Study

2020 ◽  
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Masayasu Gakumazawa ◽  
Mafumi Shinohara ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Survival Prediction ◽  
Trauma Patients ◽  
Interval Group ◽  
Trauma And Injury

Abstract Background: In-hospital mortality in trauma patients decreased recently owing to improved trauma injury prevention systems. However, no study which evaluated the validity of Trauma and Injury Severity Score (TRISS) in pediatrics by detailed classification of patients’ age and injury severity in Japan. This retrospective nationwide study evaluated the validity of TRISS in predicting survival in Japanese pediatric patients with blunt trauma by age and injury severity.Methods: Data were obtained from the Japan Trauma Data Bank during 2009−2018.Results: In all age categories, the area under the curve (AUC) for TRISS demonstrated high performance (0.935, 0.981, 0.979, and 0.977). The Accuracy of TRISS was 99.9%, 98.2%, 92.1%, 76.7%, 55.3%, and 72.1% in survival probability (Ps) interval groups (0.96−1.00), (0.91−0.95), (0.76.−0.90), (0.51−0.75), (0.26−0.50), and (0.00−0.25), respectively. The AUC for TRISS demonstrated moderate performance in the Ps interval group (0.96−1.00) and low performance in other Ps interval groups.Conclusions: The TRISS methodology appears to predict survival accurately in Japanese pediatric patients with blunt trauma; however, there were several problems in adopting the TRISS methodology for younger blunt trauma patients with higher injury severity. In the future, we should consider to conducting a simple, high-quality prediction model that is more suitable for pediatric trauma patients than the current TRISS model.

Lactate in Trauma: A Poor Predictor of Mortality in the Setting of Alcohol Ingestion

2011 ◽  
Vol 77 (12) ◽  
pp. 1576-1579 ◽  
Author(s):  
Hadley K. Herbert ◽  
Tracey A. Dechert ◽  
Luke Wolfe ◽  
Michel B. Aboutanos ◽  
Ajai K. Malhotra ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Alcohol Ingestion ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
End Point ◽  
Blood Alcohol Levels ◽  
Level I

Resuscitation end point markers such as lactate and base deficit (BD) are used in trauma to identify and treat a state of compensated shock. Lactate and BD levels are also elevated by alcohol. In blunt trauma patients with positive blood alcohol levels, lactate may be a poor indicator of injury. Retrospective data were collected on 1083 blunt trauma patients with positive blood alcohol levels admitted a Level I trauma center between 2003 and 2006. Patients were stratified by Injury Severity Score, age, gender, and Glasgow Coma Score. Logistic regression analyses were used to assess lactate and BD as independent risk factors for mortality. Seventy-four per cent of patients had an abnormal lactate level compared with 28 per cent with abnormal BD levels. In patients with mild injury, lactate levels were abnormal in more than 70 per cent of patients compared with less than 20 per cent of patients with abnormal BD levels. Linear regression showed lactate is not a significant predictor of mortality. Regardless of Injury Severity Score, lactate appeared to be more often abnormal than BD in the setting of alcohol ingestion. Additionally, because BD, and not lactate, was shown to be an independent predictor of mortality, lactate may not be a reliable marker of end point resuscitation in this patient population.

scholarly journals Validation of age-specific survival prediction in pediatric patients with blunt trauma using trauma and injury severity score methodology: a ten-year Nationwide observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Masayasu Gakumazawa ◽  
Mafumi Shinohara ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Predictive Value ◽  
Severity Score ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Age Groups ◽  
Survival Prediction ◽  
Trauma Patients ◽  
Trauma And Injury

Abstract Background In-hospital mortality in trauma patients has decreased recently owing to improved trauma injury prevention systems. However, no study has evaluated the validity of the Trauma and Injury Severity Score (TRISS) in pediatric patients by a detailed classification of patients’ age and injury severity in Japan. This retrospective nationwide study evaluated the validity of TRISS in predicting survival in Japanese pediatric patients with blunt trauma by age and injury severity. Methods Data were obtained from the Japan Trauma Data Bank during 2009–2018. The outcomes were as follows: (1) patients’ characteristics and mortality by age groups (neonates/infants aged 0 years, preschool children aged 1–5 years, schoolchildren aged 6–11 years, and adolescents aged 12–18 years), (2) validity of survival probability (Ps) assessed using the TRISS methodology by the four age groups and six Ps-interval groups (0.00–0.25, 0.26–0.50, 0.51–0.75, 0.76–0.90, 0.91–0.95, and 0.96–1.00), and (3) the observed/expected survivor ratio by age- and Ps-interval groups. The validity of TRISS was evaluated by the predictive ability of the TRISS method using the receiver operating characteristic (ROC) curves that present the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the receiver operator characteristic curve (AUC) of TRISS. Results In all the age categories considered, the AUC for TRISS demonstrated high performance (0.935, 0.981, 0.979, and 0.977). The AUC for TRISS was 0.865, 0.585, 0.614, 0.585, 0.591, and 0.600 in Ps-interval groups (0.96–1.00), (0.91–0.95), (0.76. − 0.90), (0.51–0.75), (0.26–0.50), and (0.00–0.25), respectively. In all the age categories considered, the observed survivors among patients with Ps interval (0.00–0.25) were 1.5 times or more than the expected survivors calculated using the TRISS method. Conclusions The TRISS methodology appears to predict survival accurately in Japanese pediatric patients with blunt trauma; however, there were several problems in adopting the TRISS methodology for younger blunt trauma patients with higher injury severity. In the next step, it may be necessary to develop a simple, high-quality prediction model that is more suitable for pediatric trauma patients than the current TRISS model.

Safety and Efficacy of Heparin or Enoxaparin Prophylaxis in Blunt Trauma Patients With a Head Abbreviated Injury Severity Score >2

2011 ◽  
Vol 71 (2) ◽  
pp. 396-400 ◽  
Author(s):  
Christian T. Minshall ◽  
Evert A. Eriksson ◽  
Stuart M. Leon ◽  
Andrew R. Doben ◽  
Brian P. McKinzie ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
Safety And Efficacy

scholarly journals The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Libing Jiang ◽  
Zhongjun Zheng ◽  
Mao Zhang
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Apache Ii ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Survival Group ◽  
Saps Ii ◽  
Scoring Tools

Abstract Purpose The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients. Methods Annual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level I trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated. Results The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE II, and SAPS II in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715, and 0.725, respectively. Conclusion The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.

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