Two Cohorts of Severely Injured Trauma Patients, Nearly Two Decades Apart: Unchanged Mortality But Improved Quality of Life Despite Higher Age

Nijboer, Johanna M. M.; Sluis, van der Corry; Naalt, van der Joukje; Nijsten, Maarten; Duis, ten Henk Jan

doi:10.1097/01.ta.0000228890.65522.53

Cited by 27 publications

(21 citation statements)

References 14 publications

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“…Also in trauma care, the geriatric patient forms a distinct entity that necessitates a variety of adjustments. Previous data from our trauma center showed an expansion of the geriatric trauma population in the last two decades [1]. Many of our elderly patients were severely injured (injury severity score > 15) after only a minor trauma incident.…”

Section: Introductionmentioning

confidence: 75%

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The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

Nijboer

Sluis

Dijkstra

et al. 2008

Eur J Trauma Emerg Surg

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The value of the trauma mechanism in the triage of severely injured elderly Nijboer, J.M.M.; van der Sluis, Corry K.; Dijkstra, Pieter U. ; ten Duis, H.J. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Abstract Background: The triage of trauma patients is currently based on the trauma mechanism. However, it is known that elderly patients can sustain severe injuries due to insignificant trauma mechanisms. As such, triage methods might be questionable. Objective: To evaluate whether current trauma triage criteria are appropriate in severely injured elderly patients. Methods: To analyze the effect of the trauma mechanism on triage and treatment, consecutive patients ‡ 55 years of age, with an injury severity score > 15, treated from 2002 to 2005 were divided into those who sustained a high-energy trauma (HET) versus a low energy trauma (LET). Pre-hospital and in-hospital data, injury characteristics, and data on mortality and disablement one year postinjury (sickness impact profile) were analyzed for HET and LET groups. Results: Age, sex and co-morbidity rate were similar in 84 HET patients and 107 LET patients. HET patients (mean ISS 28) received more sophisticated trauma care than LET patients (mean ISS 22), although mortality was similar (38 vs. 34%). Long-term disablement was also similar (median SIP scores 4 vs. 6). Severe head injuries and the Revised Trauma Score were related to mortality. Physical disablement was related to preexisting co-morbidities. No variables were related to psychosocial disablement. Conclusions: In elderly people a low energy trauma may lead to severe consequences. Not only the trauma mechanism, but also age, co-morbidity, and the likelihood of a brain injury should be leading in the triage and subsequent management of severely injured elderly.

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Section: Introductionmentioning

confidence: 75%

“…To elucidate this issue the following three questions were addressed: (1) in what way do the pre-hospital, in-hospital, and injury characteristics differ in elderly HET and LET patients? (2) Which differences in short-term and long-term outcomes between elderly HET and LET patients can be identified?…”

Section: Introductionmentioning

confidence: 99%

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

Nijboer

Sluis

Dijkstra

et al. 2008

Eur J Trauma Emerg Surg

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“…One could think that the usage of the MTP is reason for this decline [24]. The decline in crude mortality rate can be attributed to many factors, as outcome is greatly affected by time to definite care, quality of care, injury severity, and patient factors [25, 26]. Total prehospital time and trauma scores did not differ for both periods; however, the 2014 cohort was significantly older.…”

Section: Discussionmentioning

confidence: 99%

Ten year maturation period in a level-I trauma center, a cohort comparison study

Harmsen

Giannakópoulos

Terra

et al. 2016

Eur J Trauma Emerg Surg

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PurposeMany changes have been made to improve trauma care. Improved trauma team response and usage of a hybrid resuscitation room are examples of how this trauma center has developed. The aim was to assess how the outcome of the trauma population was influenced by the maturation.MethodsA cohort comparison, between June 2004–July 2005 and 2014, was performed. All adult trauma patients with an Injury Severity Score (ISS) >15 were included. Variables collected were: patient demographics, mechanism of trauma, total prehospital time, pre- and inhospital trauma scores, vital signs, blood values and interventions, and physician staffed helicopter emergency medical services (P-HEMS) involvement and outcome.ResultsFrom June 2004 to July 2005 219, patients were admitted, and for the year 2014, this was 282 patients. The 2014 cohort was significantly older (mean age of 53.6 ± 23.8 vs 45.6 ± 22.7 years). The mean RTS did not differ. P-HEMS assists increased to 116 (13.5 %). The number of CT scans, blood transfusion, and acute trauma surgical interventions decreased. Mean LOS, ICU admission, and ICU LOS did not differ. The mortality rate, however, decreased by 7.0 %, observed and predicted survival was significantly different in favour of the 2014 cohort, with a Z-score of 4.25.ConclusionAn increase in age is seen, though trauma scores remain comparable. The number of blood products transfused and acute trauma surgical interventions performed declines. Mortality significantly decreased and a significant difference in observed and predicted survival is seen. Showing improved trauma care in our hospital, in favour of the second period.

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“…The evaluation of functional outcome was assessed at baseline, one month, six months and 12 months using the extended Glasgow Outcome Scale (GOSE) [24]–[25]. The SF is well-validated, reliable and sensitive to change and has been extensively used to assess and follow up trauma patients [26]–[27].…”

Section: Methodsmentioning

confidence: 99%

A Comparison of Functional Outcome in Patients Sustaining Major Trauma: A Multicentre, Prospective, International Study

et al. 2014

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ObjectivesTo compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia.Summary Background DataMulticentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR).MethodsMulticentre, prospective cohort study. Major trauma patients and aged ≥18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE) functional outcome and risk-adjusted Short-Form 12 (SF-12) health status at 6 and 12 months after injury.Results261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17), and at 12 months was 0.83 (95% CI: 0.60, 1.12). Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: −1.2, 3.6) and 12-months (adjusted mean difference: −0.4, 95% CI: −3.2, 2.4) compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: −2.1, 2.8) or 12-months (adjusted mean difference: 1.8, 95% CI: −0.8, 4.5).ConclusionThe unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions.

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Two Cohorts of Severely Injured Trauma Patients, Nearly Two Decades Apart: Unchanged Mortality But Improved Quality of Life Despite Higher Age

Cited by 27 publications

References 14 publications

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

Ten year maturation period in a level-I trauma center, a cohort comparison study

A Comparison of Functional Outcome in Patients Sustaining Major Trauma: A Multicentre, Prospective, International Study

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