Geriatric Trauma

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Kevin Biese MD, MAT
Kristen Barrio MD
Geriatric Trauma – Quick Fact Sheet
Epidemiology
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Patients ≥ 65 years are 10% of all traumas, but 28% of deaths
Trauma is the 7th leading cause of death in elderly
Falls are the most common trauma mechanism
Motor vehicle collision (MVC) is the most fatal trauma mechanism
General Principles
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Cardiac and pulmonary disease and medications may limit physiological response to stressors,
(i.e. beta blockers, etc)
Trauma patients are under-triaged in violation of paramedic protocols
Changing trauma team activation thresholds for elderly patients has been shown to decrease
mortality
Head Trauma
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Patients aged >65 y/o have 30-85% mortality with intracranial hemorrhage (ICH)
ICH can occur from seemingly minor trauma, such as a fall from standing
Age ≥ 65 considered high risk in both Canadian and New Orleans Head CT protocols
Subdural hematomas account for majority of findings on Head CT
Beware of delayed acute subdural hematoma (DASH) – consider admission for observation even
if negative head CT
Warfarin
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Risk of spontaneous ICH on warfarin is 0.3-5.4%
Blunt head trauma on warfarin with minimal or no symptoms: 7-14% have ICH
Remember patients frequently have supra-therapeutic INR: 11% with INR >5
For patients with head injury on warfarin, reduced mortality if protocol implemented requiring
immediate head CT and FFP be ordered
Cervical Spine Trauma
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In blunt trauma victims age>65, C-spine fractures are 2x more likely than in younger patients
Odontoid fractures: 20% of elderly c-spine fractures compared to 5% in younger patients
Patients >65 included in NEXUS criteria and identified as high risk in Canadian C-Spine Rule
Chest Trauma
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In elderly patients with isolated thoracic injuries, mortality of patients >65 was 15%
If patient has 3 or more rib fractures mortality was > 30%
Most mortality subsequent to pneumonia
Pelvic Trauma
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In pelvic fractures, elderly patients have high rates of hemorrhage, transfusion, and ICU
admission even with a benign fracture pattern (lateral compression)
There is some evidence that early angiographic embolization is helpful in elderly patients with
pelvic trauma
Hip fractures have 15-20% mortality rate within the first year. Between 25-50% of patients will
not regain the ability to ambulate
Burn Injuries
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Elderly patients represent 1/5 of all burn unit admissions
Traditional mortality estimate is age + %burn
References
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Bergeron et al. Elderly trauma patients with rib fractures are at greater risk of death and
pneumonia. J of Trauma 2003; 54: 478-85.
Callaway, Wolfe. Geriatric Trauma. Emerg Med Clin 2007; 25: 837-860.
Demetriades et al. Effect on outcome of early intensive management of geriatric trauma
patients. Brit J Surg 2002; 89: 1319-1322.
Demetriades et al. Old age as a criterion for trauma team activation. J Trauma 2001; 51:
754-7.
Hylek et al. Major hemorrhage and tolerability of warfarin in the first year of therapy among
elderly patients with atrial fibrillation. Circulation AHA 2007; 115: 2689-2696
Ivascu et al. Rapid warfarin reversal in anticoagulated patients with traumatic intracranial
hemorrhage reduces hemorrhage progression and mortality. J Trauma 2005; 59: 11311139.
Kimbrell et al Angiographic embolization for pelvic fractures in older patients. Arch Surg
2004; 139: 728-733.
Ma et al. Compliance with prehospital triage protocols for major trauma patients. J
Trauma. 1999 Jan; 46(1) 168-75.
Meldon S, Ma O., Woolard R. Geriatric Emergency Medicine. McGraw Hill, 2004.
Touger et al. Validity of a decision rule to reduce cervical spine radiography in elderly
patients with blunt trauma. Ann Emerg Med. 2002 Sep; 40(3): 287-93.
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