Older age, comorbid illnesses, and injury severity affect immediate outcome in elderly trauma patients

Kirshenbom, Dvora; Ben-Zaken, Zila; Albilya, Nehama; Niyibizi, Eva; Bala, Miklosh

doi:10.4103/jets.jets_62_16

Cited by 50 publications

(13 citation statements)

References 17 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%

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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%

“…It was also found that with each increase in the CCI score, the risk of death, regardless of age adjustment, increased by 41%. Comorbidities may contribute to negative ICU outcomes, such as the greater possibility of complications (9,19,(23)(24) . In this sense, it is important to adopt a classification system that is capable, in…”

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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“…At the same time, it is important to acknowledge that age alone is not a strong predictive factor of outcomes. [25][26][27][28] There is increasing evidence that intensive care may need to use other prognostic indicators as well as age, such as the level of frailty. [29,30] Moreover, the increased incidence of co-morbidities in the elderly also contributes to the increased mortality and the degree of frailty.…”

Section: Discussionmentioning

confidence: 99%

The changing nature of the population of intensive-care patients

Athari

Hillman

Frost

2018

JHA

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Background: The increase in the number of Australia’s frail, very elderly ( 80 years of age) population will have an impact on admissions to intensive care. As the number of very elderly patients increase, it will be important to have information about what the impact of increasing age will have on aspects such as: the impact of age and chronic health conditions on intensive care treatment, and the impact on prognosis in the short and longer-term as well as how we should be involving the very elderly in determining their own goals of care.Objective: To evaluate the long-term trend in the rates of the very elderly ( 80 years of age) admitted to intensive care, as well as describe their chronic health conditions, length of stay, and mortality rates.Methods: This study was a retrospective review that used a database from a 40-bed, multidisciplinary, adult intensive care unit (ICU), located in South-Western Sydney, Australia. The setting is an 877-bed tertiary hospital that has medical and surgical specialties; including a referral trauma unit, with approximately 80,000 admissions a year. Data were acquired over 15-years, from January 1st, 2000 to December 31st, 2015.Results: Data were available for 32,796 patients, and of these, 4,137 (12.5%) were aged ≥ 80 years. The percentage of the very elderly admitted to ICU progressively increased from 8.6% in 2000 to (14.5% in 2015, p < .001). Overall, the median length of stay (LOS) in the ICU was 2-days (interquartile range: 1.2-4.1), and increased from 2.0 to 2.3 (p < .001). Similarly, the median hospital LOS increased over time from 9 to 11 days (p < .001). Intensive care and hospital death rates decreased over time from 19.9% to 9.8% (p < .001), and 31.8% to 19.9% (p < .001), respectively. The majority of the very elderly were admitted from the emergency department (ED) (38.1%), other sources of admission being from the operating theatres (OT) (33.5%), and the general ward (18.1%).Conclusions: The number and percentage of very elderly patients being managed in ICU is increasing, representing a different population from the one that much of our practice has been previously based. For example, we may need to review the way we estimate severity of illness on admission to the ICU with more weight given to the chronic health component of the very elderly. The acute indications for admission to ICU such as falls and infections are relatively straightforward to manage and usually have a good outcome. However, because age and the chronic health status of the very elderly are largely progressive and irreversible, we as health care professionals working in intensive care may have to consider longer-term post hospital outcomes as a basis for evaluating the effectiveness of the interventions in ICU.

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“…Higher age is an independent risk factor for trauma-related death; patients are twice as likely to die if they are 65 years and older [ 7 – 11 ]. In older patients, the preexistence of typical age-dependent medical conditions, such as diabetes, high blood pressure, reduced respiratory, and cardiac capacity, as well as polypharmacy, is the rule rather than the exception [ 12 ]. Following trauma, those conditions contribute to an increased risk of complications, such as sepsis and multi-organ failure [ 9 , 12 ], thereby contributing to a higher mortality rate [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Training to identify red flags in the acute care of trauma: who are the patients at risk for early death despite a relatively good prognosis? An analysis from the TraumaRegister DGU®

et al. 2020

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Background: In the acute care of trauma, some patients with a low estimated risk of death die suddenly and unexpectedly. In this study, we aim to identify predictors for early death within 24 h following hospital admission in low-risk patients. Methods: The TraumaRegister DGU® was used to collect records of patients who were primarily treated in a participating hospital between 2004 and 2013 with a RISC II score below 10%. Results: During the study period, 64,379 patients met the inclusion criteria. The mean RISC II score was 2.0%, and the mean ISS was 16 ± 9. The overall hospital mortality rate was 2.1%, and 0.5% of patients (n = 301) died within the first 24 h. A SPB of ≤ 90 mmHg was associated with an increased risk of death (p < 0.001). An AIS abdomen score of ≥ 3 was associated with increased risk of death within the first 24 h (p < 0.001). A high risk of early death was also seen in patients with an AIS score (thorax) ≥ 3; 51% of those who died died within the first 24 h (p < 0.005). Death in patients over 60 years was more common after 24 h (p < 0.001). Patients with an ASA score of ≥ 3 were more likely to die after the first 24 h (p < 0.001). Conclusions: Indicators predicting a high risk of early death in patients with a low RISC II score include a SPB ≤ 90 mmHg and severe chest and abdominal trauma. Emergency teams involved in the acute care of trauma patients should be aware of these "red flags" and treat their patients accordingly.

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Older age, comorbid illnesses, and injury severity affect immediate outcome in elderly trauma patients

Cited by 50 publications

References 17 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

The changing nature of the population of intensive-care patients

Training to identify red flags in the acute care of trauma: who are the patients at risk for early death despite a relatively good prognosis? An analysis from the TraumaRegister DGU®

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