Factors affecting mortality in older trauma patients—A systematic review and meta-analysis

Sammy, Ian; Lecky, Fiona; Sutton, Anthea; Leaviss, J; O’Cathain, Alicia

doi:10.1016/j.injury.2016.02.027

Cited by 111 publications

(108 citation statements)

References 64 publications

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“…Worse prognosis for traumatized elderly compared to younger patients has been constantly presented in the literature (8)(9)(22)(23)(24)(25) . This weakness is explained by characteristics of the elderly population that make it more vulnerable, such as comorbidities and the use of medications that impact the physiological response to the injury and complicate treatment and recovery (26) .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for death of trauma patients admitted to an Intensive Care Unit

Lentsck

Oliveira

Corona

et al. 2020

Rev. Latino-Am. Enfermagem

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Objective: To analyze the risk factors for death of trauma patients admitted to the intensive care unit (ICU). Method: Retrospective cohort study with data from medical records of adults hospitalized for trauma in a general intensive care unit. We included patients 18 years of age and older and admitted for injuries. The variables were grouped into levels in a hierarchical manner. The distal level included sociodemographic variables, hospitalization, cause of trauma and comorbidities; the intermediate, the characteristics of trauma and prehospital care; the proximal, the variables of prognostic indices, intensive admission, procedures and complications. Multiple logistic regression analysis was performed. Results: The risk factors associated with death at the distal level were age 60 years or older and comorbidities; at intermediate level, severity of trauma and proximal level, severe circulatory complications, vasoactive drug use, mechanical ventilation, renal dysfunction, failure to perform blood culture on admission and Acute Physiology and Chronic Health Evaluation II. Conclusion: The identified factors are useful to compose a clinical profile and to plan intensive care to avoid complications and deaths of traumatized patients.

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Section: Discussionmentioning

confidence: 99%

Risk factors for death of trauma patients admitted to an Intensive Care Unit

Lentsck

Oliveira

Corona

et al. 2020

Rev. Latino-Am. Enfermagem

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“…Previous studies have commonly focused on mortality following major trauma in older persons , and, as demonstrated in a recent systematic review, there is limited information on the long‐term outcomes in older injured patients. The aims of this study were to describe temporal trends in the incidence, causes and functional outcomes of major trauma in older adults in Victoria, Australia.…”

Section: Introductionmentioning

confidence: 99%

Major trauma in older persons

et al. 2018

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BackgroundGlobally, populations are ageing, creating challenges for trauma system design. Despite this, little is known about causes of injury and long‐term outcomes in older injured patients. This study aims to describe temporal trends in the incidence, causes and functional outcomes of major trauma in older adults.MethodsThe population‐based Victorian State Trauma Registry was used to identify patients with major trauma aged 65 years and older with a date of injury between 1 January 2007 and 31 December 2016. Temporal trends in population‐based incidence rates were evaluated. Functional outcome was measured using the Glasgow Outcome Scale – Extended.ResultsThere were 9250 older adults with major trauma during the study period. Low falls were the most common mechanism of injury (62·5 per cent), followed by transport‐related events (22·2 per cent) and high falls (9·5 per cent). The number of patients with major trauma aged 65 years and older more than doubled from 2007 to 2016, and the incidence increased by 4·3 per cent per year (incidence rate ratio 1·043, 95 per cent c.i. 1·035 to 1·050; P < 0·001). At 12 months after injury, 41·8 per cent of older adults with major trauma had died, and 52·2 per cent of those who survived to hospital discharge were not living independently.ConclusionsThe number and proportion of older adults with major trauma are increasing rapidly and this will impact on trauma system design. Given the poor long‐term outcomes, there needs to be greater emphasis on ensuring that appropriate interventions are targeted to the right patients and enhanced efforts in primary prevention.

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“…Clinical studies have reported that adult trauma victims, including patients with hemorrhagic shock, have considerably higher mortality rate than pediatric population [1–3]. Aging is, in fact, a risk factor for development of multiple organ failure and correlates with changes in myocardial function and biochemistry thus affecting the hemodynamic compensation to severe hemorrhage [4–7].…”

Section: Introductionmentioning

confidence: 99%

Metformin ameliorates gender-and age-dependent hemodynamic instability and myocardial injury in murine hemorrhagic shock

Matsiukevich¹,

Piraino²,

Lahni³

et al. 2017

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Diseas

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Severity of multiple organ failure is significantly impacted by age and gender in patients with hemorrhagic shock. However, the molecular mechanisms underlying the enhanced organ injury are not fully understood. AMP-activated protein kinase (AMPK) is a pivotal orchestrator of metabolic responses during stress. We investigated whether hemorrhage-induced myocardial injury is age and gender dependent and whether treatment with metformin, an AMPK activator, affords cardioprotective effects. C57/BL6 young (3–5 months) and mature (9–12 months) male and female mice were subjected to hemorrhagic shock by blood withdrawing followed by resuscitation with blood and Lactated Ringer’s solution. Vehicle-treated young and mature mice of both genders had a similar elevation of plasma inflammatory cytokines at 3 hours after resuscitation. However, vehicle-treated male mature mice experienced hemodynamic instability and higher myocardial damage than young male mice, as evaluated by echocardiography, histology and cardiovascular injury biomarkers. There was also a gender-dependent difference in cardiovascular injury in the mature group as vehicle-treated male mice exhibited more severe organ injury than female mice. At molecular analysis, vehicle-treated mature mice of both genders exhibited a marked downregulation of AMPKα activation and nuclear translocation of peroxisome proliferator-activated receptor γ co-activator α when compared with young mice. Treatment with metformin improved cardiovascular function and survival in mature animals of both genders. However, specific cardioprotective effects of metformin were gender-dependent. Metformin did not affect hemodynamic or inflammatory responses in young animals. Thus, our data suggest that targeting metabolic recovery with metformin may be a potential treatment approach in severe hemorrhage in adult population.

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Factors affecting mortality in older trauma patients—A systematic review and meta-analysis

Cited by 111 publications

References 64 publications

Risk factors for death of trauma patients admitted to an Intensive Care Unit

Risk factors for death of trauma patients admitted to an Intensive Care Unit

Major trauma in older persons

Metformin ameliorates gender-and age-dependent hemodynamic instability and myocardial injury in murine hemorrhagic shock

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