Assessment of factors affecting the outcome of elderly blunt trauma in Emergency Department

ABSTRACT The purpose of this study is to evaluate factors affecting the outcome of elderly blunt trauma in emergency department. The study was conducted on 100 elderly patients age above 60 years with blunt trauma admitted to Emergency Department of Alexandria Main University Hospital. Primary survey, secondary survey and radiological investigations were done for these patients. Evaluation of patient injury severity by injury severity score (ISS) .Patient outcome as regard death, discharge, transfer and complications due to trauma or treatment were reported. Falling down was the most common mechanism of injury in our study occurred in 49% of cases followed by RTA in 27 % of cases but RTA was the most common cause of injury leading to death. 93% of cases had systolic blood pressure ≥ 90 mmHg who considered hemodynamically stable on admission and 7% of cases had systolic blood pressure <90 mmHg who considered hemodynamically unstable on admission. Systolic blood pressure on admission was directly proportional with the outcome (p<0.001). GCS of our patients in this study ranged between 4 and 15 with a mean± SD of 13.98 ± 2.72 and median of 15. There were 88 % of cases with GCS more than 12 .4% of cases with GCS between 9 and 12 while 8% of cases had a GCS less than or equal to 8, the mortality is inversely proportion to GCS (p<0.001) ISS in our study ranged between 1.0 - 35.0 with mean ± SD of 8.54 ± 9.70 and median of 5, ISS was directly proportional with the outcome and higher ISS was associated with higher mortality. As regard past illness 22 patients had no past illness while the most common past illness was hypertension which presented in 31 patients and the least common past illness was cerebrovascular stroke and psychosis each present in 5 % of cases .Regarding lines of treatment, 55 patients had conservative treatment and 8 patients were unfit for surgery while surgical interventions were done for 37 patients. According to complications in our study, 76 patients (76%) had no complications while 24 patients (24%) had complications where the most common complication was pneumonia which presented in 7 patients (7%) followed by DKA and DIC which presented in 5 patients (5%) in each of them and the most common complication which associated with the highest ratio for mortality after geriatric trauma was DIC. Key words : outcome, elderly, blunt trauma REFERENCES Mitchell RJ, Chong S. (2010 )Comparison of injury-related hospitalized morbidity and mortality in urban and rural areas in Australia. Rural Remote Health ;10(1):1326-1340 Richmond TS, Kauder D, Strumpf N, Meredith T (2002) Characteristics and outcomes of serious traumatic injury in older adults. J Am GeriatrSoc ; 50: 215–22. Pudelek B (2002) Geriatric trauma: special needs for a special population. AACN Clin Issues;13:61–72. McMahon DJ, Shapiro MB, Kauder DR (2000). The injured elderly in the trauma intensive care unit.SurgClin North Am ;80:1005–19. Taylor MD, Tracy JK, Meyer W, et al. (2002) Trauma in the elderly: intensive care unit resource use and outcome. J Trauma;53:407–14 Broos P(1993) Multiple trauma in elderly patients: factors influencing outcome. Injury ; 24(6):365–8. Rob Gowing, Minto K. Jain (2007). Injury patterns and outcomes associated with elderly trauma victims in Kingston, Ontario Can J Surg, December ; 50(6):437–44 Yılmaz S, karcıoglu O, Sener S (2006). The impact of associated diseases on the etiology, course and mortality in geriatric trauma patients. Eur J Emerg Med ; 13: 295-298 Donmez L, Gokkoca Z. (2003)Accident profile of olderpeople in Antalya City Center, Turkey. ArchGerontol Geriatr ; 37: 99-108. José Gustavo , Silvia C , Jaqueline A. Giannini, Camila C. Padovese, et al (2010 ). comparative analysis of the characteristics of traumassuffered by elderly and younger patients. Rev Assoc Med Bras ; 56(5): 541-6. Rogério Silva Lima, Maria Luíza Pesse Campos (2011). Profile of the elderly trauma victims assisted at an Emergency Unit. Rev Esc Enferm USP ; 45(3):657-62. Cheng-Shyuan Rau, Tsan-Shiun Lin, Shao-Chun Wu, Johnson Chia-Shen Yang, Shiun-Yuan Hsu et al. (2014 ) Geriatric hospitalizations in fall-related injuries. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 22:63. Knudson MM, Lieberman J, Morris J. (1994) Mortality factors in geriatric blunt trauma patients.Arch Surg ;129(4):448–53 Horst HM, Obeid FN, Sorensen VJ (1986 ). Factors influencing survival of elderly trauma patients. Crit Care Med ;14(8):681–4. Rozzelle CJ, Wofford JL, Branch CL.( 1995 )Predictors of hospital mortality in older patients with subdural hematoma. J Am Geriatr Soc ;43:240–4 Reuter F. (1989) Traumatic intracranial hemorrhages in elderly people. Advances in Neurosurgery ;17:43–8.

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