Evaluation and management of geriatric trauma

Calland, J. Forrest; Ingraham, Angela M.; Martin, Niels D.; Marshall, Gary T.; Schulman, Carl I.; Stapleton, Tristan; Barraco, Robert D.

doi:10.1097/ta.0b013e318270191f

Cited by 187 publications

(77 citation statements)

References 47 publications

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“…For our analysis we choose Medicare eligibility as a cut-point. 9,10 Therefore, all STC admissions during 2008–2012 aged 65 and older with a diagnosis of TBI (International Classification of Disease, 9 th Revision, Clinical Modification (ICD-9-CM) ) codes 800.xx, 801.xx, 803.xx, 804.xx, 850.xx–854.1x, 950.1–950.3, 959.01) were eligible for this study. The CDC recommends these ICD-9-CM codes, plus an additional code for shaken infant syndrome (995.55) that we did not include, for TBI surveillance, and they have been reported to have a sensitivity of 89% to detect severe TBI and a positive predictive value of 93%.…”

Section: Methodsmentioning

confidence: 99%

Treatment Charges for Traumatic Brain Injury Among Older Adults at a Trauma Center

Albrecht

Slejko

Stein

et al. 2017

Journal of Head Trauma Rehabilitation

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Objective To provide charge estimates of treatment for traumatic brain injury (TBI), including both hospital and physician charges, among adults aged 65 and older treated at a trauma center. Methods We identified older adults treated for TBI during 2008–2012 (n=1,843) at Maryland’s Primary Adult Resource Center and obtained hospital and physician charges separately. Analyses were stratified by sex and all charges were inflated to 2012 dollars. Total TBI charges were modeled as a function of covariates using a generalized linear model. Results Women comprised 48% of the sample. The mean unadjusted total TBI hospitalization charges for adults aged 65 and older was $36,075 (standard deviation (SD) $63,073). Physician charges comprised 15% of total charges. Adjusted mean charges were lower in women than in men (adjusted difference −$894; 95% confidence interval (CI) −$277, −$1,512). Length of hospital and ICU stay were associated with the highest charges. Conclusions This study provides the first estimates of hospital and physician charges associated with hospitalization for TBI among older adults at a trauma center that will aid in resource allocation, triage decisions, and healthcare policy.

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Section: Methodsmentioning

confidence: 99%

Treatment Charges for Traumatic Brain Injury Among Older Adults at a Trauma Center

Albrecht

Slejko

Stein

et al. 2017

Journal of Head Trauma Rehabilitation

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“…34–36 The most recent Eastern Association for the Surgery of Trauma (EAST) Guideline suggests that all elderly patients on pre-hospital systemic anticoagulation who are suspected of having a head injury should undergo rapid head CT evaluation. 37 It is also recommended that head-injured patients on warfarin should undergo rapid (within 2 hours of presentation) reversal of warfarin with fresh frozen plasma (FFP) and vitamin K. 37,38 McMillian, et. al.…”

Section: Icu Circulatory Considerationsmentioning

confidence: 99%

Acute Management of Traumatic Brain Injury

Vella

Crandall

Patel

2017

Surgical Clinics of North America

239

163

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Synopsis Traumatic brain injury (TBI) is a leading cause of death and disability in trauma patients. As the primary injury cannot be undone, management strategies must therefore focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow (CBF). Cerebral perfusion pressure can be maintained by increasing mean arterial pressure (MAP), decreasing intracranial pressure (ICP), or both. MAP can be increased through a combination of pressors in the euvolemic state, although the ideal fluid in TBI patients is unknown. The goal should be euvolemia and avoidance of hypotension. Elevated intracranial pressure can be treated through an algorithmic approach utilization simple bedside maneuvers, hyperosmolar therapy, cerebral spinal fluid (CSF) drainage as well as pentobarbital coma and decompressive craniectomy in refractory cases. Mass lesions may require operative evacuation depending on size, exam findings, and ICP measurements. Although CPP may not be an ideal surrogate for cerebral blood flow and metabolic delivery, other modalities have not gained widespread use due to paucity of strong data. Other factors that deserve important consideration in the acute management of TBI patients are venous thromboembolism, stress ulcer, and seizure prophylaxis as well as nutritional and metabolic optimization.

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“…While the care of injured children is based on well-defined protocols and dedicated services, there are few such guidelines or recommendations for the care of GTPs. 7 Less than 20% of responders had specific geriatric protocols or order sets. Even fewer centers use geriatric advance practitioners or specially trained nurses.…”

Section: Member Surveymentioning

confidence: 99%