File - Amy Toman e

Geriatric Trauma: Factors that Effect Outcomes
Amy Toman
Siena Heights University
Zora Cvetkovsi-Injic
February 17, 2013
Adams, S., Cotton, B., McGuire, M., Dipasuil, E., Podbielsi, J., Zaharia, A., ... Holcomb, J.
(2012). Unique pattern of complications in elderly trauma patients at a level 1 trauma
center. J Trauma, 72(1), 112-118.
This is a review of the trauma registry over a 14 year period that compared age, Injury Severity
Scores (ISS), mechanism of injury, mortality, complication rates, and length of stay. The
research found that advanced age with a higher ISS was associated with increased
mortality. It was also shown that around the age of 45 to be the “breaking point” for
increased complications. Length of stay was longer for the elderly patient when
combined with injury severity and comorbidites. Age alone did not impact length of stay.
Calland, J., Ingraham, A., Martin, N., Marshall, G., Schulman, C., Stapleton, T., & Barraco, R.
(2012). Evaluation and management of geriatric trauma: An eastern association for the
surgery of trauma practice management guideline. Journal of Trauma Acute Care
Surgery, 73, 345-350.
This article reviews the literature as it relates to elderly trauma patients to answer questions
related to triage, anti-coagulation, and intensive monitoring. From the review it was determined
that elderly trauma patients are under-triaged which could result in poor outcomes. Anticoagulation was looked at as per the need to reverse anti-coagulation when there is a confirmed
or suspected intracrainial bleed. It provides an algorithm for health care professionals to follow
as evidence-based care of the elderly trauma patient.
Dillon, B., Wang, W., & Bouamra, O. (2006). A comparison study of the injury score models.
European Journal of Trauma, 6, 538-547.
This study looks at the Injury Severity Score (ISS) and compares it to other injury predictor
scales. The ISS looks at injury location and number of injuries. The higher the number the more
likely a patient will have complications or die. The study found that when compared to other
injury severity scales, the ISS is still the best method for predicting mortality and morbidity.
Evans, D., Cook, C., Christy, J., Murphy, C., Gerlach, A., Eiferman, D., ... Whitmill, M. (2012).
Comorbidity-polypharmacy scoring facilitates outcome prediction in older trauma
patients. Journal of the American Geriatrics Society, 60(8), 1465-1470.
This study looked at comorbidity-polypharmacy score (CPS) to determine if there was an effect
on patients older than 45. Each patient in the study was given a CPS score based on the number
of medications taken and the number of co-morbid conditions. It was determined that a higher
CPS is associated with increased mortality, complications, longer length of stay, and discharge to
an extended care facility.
Grossman, M., Miller, D., Scaff, D., & Acona, S. (2002). When is an elder old? Effect of
preexisting conditions on mortality in geriatric trauma. J Trauma, 52, 242-246.
This was a 13 year study of a state-wide trauma data base to determine if pre-existing conditions
effected outcomes of elderly trauma patients. It was found that specific co-morbidities affect
mortality. Of the co-morbidities looked at liver disease, kidney disease, and congestive heart
failure were found to have the most affect on mortality.
Jacobs, D. (2003). Special considerations in geriatric injury. Current Opinion in Critical Care, 9,
This literature review looks at geriatric trauma though what is missing in the literature. Jacobs
brings into question whether or not aggressive treatment is intentionally withheld from elderly
trauma based on age. There is a lack of data to either support or deny this. Jacobs also provides
supporting data on incorporating a geriatric injury prevention program to help prevent injury.
Keller, J., Sciadini, M., Sinclair, E., & O’Toole, R. (2012). Geriatric trauma: demographics,
injuries, and mortality. Journal of Orthopedic Trauma, 26, e161-e165.
This is a retrospective study of all trauma patients over a 5 year period at an academic trauma
center. The study was done to determine if elderly trauma patients had a higher mortality rate
then younger patients with similar injuries. This study found that elderly patients are 3 times
more likely to die of their injuries than younger patients. Reasons for the increased mortality
include decreased trauma activation, co-morbidities of the elderly trauma patient, and difficulty
in initially assessing the severity of injury.
Labib, N., Nouh, T., Wincour, S., Deckelbaum, D., Banici, L., Fata, P., ... Khwaja, K. (2011).
Severly injured geriatric population: Morbidity, mortality, and risk factors. J Trauma, 71,
This is a chart review of all trauma patients older than 65 at a level 1 trauma center to look at
prognosis as it relates to care of the elderly patient. This study showed that co-morbidities along
with injury severity are associated with increased mortality. The average length of stay for these
patients were longer than younger patients with similar injuries. It was also determined that these
elderly patients were admitted to the ICU more frequently than younger patients.
Mangram, A., Mitchell, C., Shifflette, V., Lorenzo, M., Truitt, M., Goel, A., ... Nicholes, D.
(2012). Geriatric trauma service: A one year experience. J Trauma, 72(1), 119-122.
To improve patient outcomes this study looked at the effect of using multi-disciplinary trauma
rounding. It compared groups of patients who were rounded on to those that did not have team
rounding. The study found that those patients who had the multi-disciplinary rounding had fewer
complications than the other group. They noticed a decrease incidence of urinary tract infections,
congestive heart failure, pneumonia, renal failure, and deep vein thrombosis.
Min, L., Ubhayakar, N., Salibaa, D., Quon, L., Morley, E., Hiatt, J., ... Tillou, A. (2011). The
vulnerable elders survey-13 predicts hospital complications and mortality in older adults
with traumatic injury. JAGS, 59, 1471-1476.
This study evaluates the Vulnerable Elderly Survey (VES)- 13 to determine if it can be used to
predict outcomes. The VES screens patients as to their functional level prior to hospitalization
and compared the outcomes. The research showed that VES can be used to help predict
morbidity and mortality in older adults. However, there are some limitations to the study due to
limited sample size.
Newton, K. (2001). Geriatric trauma. Top Emergency Medicine, 23(3), 1-12.
This is a literature review of that discusses the physiological changes that happen as people age
and how it affects trauma care. Annually 87 billion dollars are spent each year in treating elderly
trauma patients and it is important for us to understand how to effectively treat these patients.
This research also states that co-morbidities alone do not cause increased mortality. However,
co-morbidities do increase length of stay.
Peschman, J., Neideen, T., & Brasel, K. (2011). The impact of discharging minimally injured
trauma patient: Does age play a role in trauma admission? The Journal of Trauma Injury,
Infection, and Critical Care, 70(6), 1331-1336.
This research article compares elderly trauma patients with younger patients with similar injuries
to determine if the elderly are admitted to the hospital more frequently. The research found that
elderly trauma patients are four time more likely to be admitted to the hospital than younger
patients with similar injuries. This study also found that elderly trauma patients were admitted to
the Intensive Care Unit more frequently, had a higher mortality, and had longer lengths of stay
then younger patients with similar injuries.
Pudelek, B. (2002). Geriatric trauma: Special needs for a special population. AACN Clinical
Issues, 13, 61-72.
This article defines the physiologic changes that occur in the elderly and how it corresponds with
specific traumatic injuries. It discusses the specific needs of the elderly in a systematic way and
gives recommendations based on the current literature. An example that is discussed is that
special attention should be placed on mobility. Early ambulation or increase activity helps to
decrease complications that could impact length of stay.
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