trauma in the elderly; geriatric trauma
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Etiology
- falls in the elderly
- hip fracture (more common in women)
- falls associated with syncope may be recurrent[5]
- head injury is often associated with facial trauma[5]
- automobile accidents
Epidemiology
- trauma increases in mortality rate at ages 55, 77, & 82 years
Pathology
- low physiological reserve & the altered response to injury*
* see age-related physiological changes
Clinical significance
- variables of age, injury severity score, & 24-hour transfusion are components of a multivariate model to predict 1-year mortality[3]
- the frailty index is an independent predictor of in-hospital complications & adverse discharge disposition in geriatric trauma patients[4]
- mechanism of injury, vital signs on presentation, comorbidities, & medications are also associated with in-hospital complications, longer length of stay, & adverse discharge disposition in elderly trauma patients[4]
- systolic blood pressure & resiratory rate most significant vital signs[4]
- falling from standing & sustaining sufficiency injury to warrant hospitalization is a marker for frailty & comorbidities[7]
Complications
- see Complications section of hospitalization
- trauma associated with anticoagulant or anti-platelet agent use increases risk of bleeding
- a delay may be observed in bleeding associated with head injury[5]
- older adults are more likely than adults < 55 years to be discharged to a skilled nursing facility
Management
- triage:
- transfer to trauma center*
- systolic BP < 90 mm Hg, < 100 mm Hg if > 70 years
- pedestrian hit by motor vehicle & > 70 years[6]
- transfer to trauma center*
- geriatric trauma pathway[7]
- goals include prevention of postoperative complications, especially postoperative dilerium & minimizing length of hospital stay
- a multidisciplinary team with representation from:
- trauma surgery
- anesthesiology
- geriatric medicine
- emergency department
- critical care
- nursing
- physical therapy & occupational therapy
- speech pathology & language pathology
- case management
- social work
- pharmacy
- nutrition
- transitional care
- quality
- patient family advisory council
- having anesthesiology as part of the multidisciplinary team is necessary for optimal geriatric pain management[7]
- geriatric medicine
- identify & manage comorbidities
- see Management section of hospitalization for general guidelines
- see Management section of hip fracture for specific recommendations
* older patients more likely to require surgery & intensive care after trauma than younger patients[6]
More general terms
Additional terms
References
- ↑ 1.0 1.1 Fakhry SM, Morse JL, Garland JM et al REDEFINING GERIATRIC TRAUMA. 55 IS THE NEW 65 J Trauma Acute Care Surg. 2021. Jan 6 AAST Poster Not indexed in PubMed https://journals.lww.com/jtrauma/Abstract/9000/REDEFINING_GERIATRIC_TRAUMA__55_IS_THE_NEW_65.97616.aspx
- ↑ Horst MA, Morgan ME, Vernon TM et al The geriatric trauma patient: A neglected individual in a mature trauma system. J Trauma Acute Care Surg. 2020 Jul;89(1):192-198 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32118822 https://journals.lww.com/jtrauma/Abstract/2020/07000/The_geriatric_trauma_patient__A_neglected.30.aspx
- ↑ 3.0 3.1 Ross SW, Adeyemi FM, Zhou M et al One-year mortality in geriatric trauma patients: Improving upon the geriatric trauma outcomes score utilizing the social security death index. J Trauma Acute Care Surg. 2019 November 87(5):1148-1155 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31318764 https://journals.lww.com/jtrauma/Abstract/2019/11000/One_year_mortality_in_geriatric_trauma_patients_.20.aspx
- ↑ 4.0 4.1 4.2 4.3 Joseph B, Pandit V, Zangbar B et al Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg. 2014 Aug;149(8):766-72. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24920308 https://jamanetwork.com/journals/jamasurgery/fullarticle/1879845
- ↑ 5.0 5.1 5.2 5.3 Gioffre-Florio M, Murabito LM, Visalli C, Pergolizzi FP, Fama F Trauma in elderly patients: a study of prevalence, comorbidities and gender differences. G Chir. 2018 Jan-Feb;39(1):35-40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29549679 PMCID: PMC5902142 Free PMC article
- ↑ 6.0 6.1 6.2 Ichwan B et al. Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults. Ann Emerg Med 2014 Jun 5 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24908590
- ↑ 7.0 7.1 7.2 7.3 Park C, Bharija A, Mesias M et al Association Between Implementation of a Geriatric Trauma Clinical Pathway and Changes in Rates of Delirium in Older Adults With Traumatic Injury. JAMA Surg. 2022 Aug 1;157(8):676-683 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35675065 PMCID: PMC9178494 (available on 2023-06-08)
Zhao B, Xing H, Ma W Implementation of a Geriatric Trauma Clinical Pathway. JAMA Surg. Published online October 5, 2022. https://jamanetwork.com/journals/jamasurgery/fullarticle/2797093
Park C, Staudenmayer K Implementation of a Geriatric Trauma Clinical Pathway- Reply JAMA Surg. Published online October 5, 2022. https://jamanetwork.com/journals/jamasurgery/fullarticle/2797091