Geriatric trauma [Elektronische Ressource] : introduction of age ≥ 70 years as a criterion for trauma team activation and the effect of early intensive management in consideration of the Injury Severiity Score / vorgelegt von Daphnie Averkiou

Mw

Sujets

• Gesundheit

Informations

• Publié par: heinrich-heine-universitat_dusseldorf
• Publié le: 01 janvier 2009
• Nombre de lectures: 16
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Aus der Klinik für Unfall - und Handchirurgie
der Heinrich-Heine-Universität Düsseldorf
Direktor: Univ.-Prof. Dr. med . Joachim Windolf







GERIATRIC TRAUMA
Introduction of age ≥70 years as a criterion for trauma team activation and the effect of early
intensive management in consideration of the Injury Severity Score



Dissertation
zur Erlangung des Grades eines Doktors der Medizin
Der Medizinischen Fakultät der Heinrich-Heine-Universität
Düsseldorf


vorgelegt von


Daphnie Averkiou




2009




0
Als Inaugraldissertation gedruckt mit Genehmigung der Mezinischen Fakultät der
Heinrich-Heine-Universität Düsseldorf




Gez .: Univ.-Prof. Dr. med. Joachim Windolf
Dekan




Referent: Prof. Dr. med. Sascha Flohé

Korreferent: Priv.-Doz. Dr. med. Stefan Topp
1


TABLE OF CONTENTS
1. Introduction.......................................................................................................................... 8
2. Patients and Methods ......................................................................................................... 10
2.1.1. Study design ................ 10
2.2. Admission criteria ...................................................................................................... 10
2.2.1. Study period ................ 10
2.2.2. Age ............................................................................................................................... 10
2.2.3. Gender ......................... 10
2.2.4. Admission criteria ........................................................................................................ 11
2.2.5. Patient groups ............. 13
2.2.6. Drop out criteria .......................................................................................................... 14
2.3. Documentary parameter of polytrauma patients ........................ 14
2.3.1. Study population ......................................................................................................... 14
2.3.2. Mechanism of injury .... 14
2.3.3. Primary diagnostic ....................................................................................................... 15
2.3.4. Types of injury ............. 15
2.3.5. Degree of injury ........................................................................................................... 15
2.3.6. Therapy ........................ 17
2.3.7. Complications .............................................................................................................. 17
2.3.8. Hospital parameters .... 18
2.4. Statistical Analysis ...................................................................................................... 18
3. Results ................................ 19
3.1. Patients documentary report for the first study period ................................................ 19
3.1.1. Study population ......................................................................... 19
3.1.2. Mechanism of injury .................................... 20
3.1.3. Degree of Injury ........................................................................... 20
2

3.1.4. ICU admission and non-orthopaedic operation .......................................................... 21
3.1.5. ICU admissions ............................................................................................................ 22
3.1.6. Mortality according to ISS and TTA criteria . 23
3.1.7. ICU admission and nonorthopedic operations according to Mechanism of Injury and
TTA Status 24
3.1.8. Mortality according the injury type ............................................................................ 25
3.2. Second study period: the effect of the new policy on outcome after 70 years old became
a TTA Criterion........................................................................................................................ 26
3.2.1. Study population ......................................... 26
3.2.2. Types of injury ............................................................................. 27
3.2.3. The most severely injures body area .......................................... 28
3.2.4. Outcome for patients aged 70 years or more with an Injury Severity Score above 15
28
3.2.5. Outcome for patients aged 70 years or more with an Injury Severity Score above 20
29
4. Discussion ........................................................................................................................... 31
4.1. General considerations ............................... 31
4.2. Injury pattern ............................................................................................................. 32
4.2.1. Fall ............................... 32
4.2.2. Automobile versus pedestrians ................................................................................... 32
4.2.3. Motor vehicles accidents ............................ 32
4.3. Physiological changes and elderly trauma by bodily system ......................................... 35
Age related cardiovascular changes ............................................................................................ 35
Age related respiratory system ................................... 36
4.3.1. Age related cardiovascular changes ............................................ 37
4.3.2. Age related respiratory system ................................................... 40
4.3.3. Renal systems .............................................................................. 41
4.3.4. Age related neurological changes ............................................... 41
3
4.3.5. Abdominal trauma ...................................................................................................... 42
4.3.6. Skeletal injury .............. 43
4.4. Post injury course ....................................................................................................... 44
4.4.1. Trauma scoring systems in the elderly trauma population ........ 44
4.4.2. Therapy and socioeconomic impact............................................................................ 46
4.4.3. Functional outcome .................................... 49
4.5. Future Directions further studies ................................................ 50
5. Summary ............................................................................................ 51
6. References .......................................................... 52
7. Lebenslauf ................................................................ 60
8. Abstract.............................................................................................................................62

4
FIGURES
Figure 1: - Trauma Triage Decision Scheme recommended from the American College of Surgeons
2006 (12) ............................................................................................................................................... 12
Figure 2: Mechanism of injury in the two groups ................. 20
Figure 3: Injury Severity Score ............................................................................................................... 21
Figure 4: Mortality percentages for both the TTA and non TTA groups according to the Injury Severity
Score ...................................................................................................................................................... 23
Figure 5: Comparative information about mortality according to the group with TTA and non TTA by
the injury type ....................................................................................................................................... 25
Figure 6: Incidence of types of injuries in the two groups .... 27
Figure 7: The overall most injured body areas measured by AIS ≥3 ..................................................... 28






5
TABLES
Table 1: LAC and USC Medical Center Standard Trauma Team Activation Criteria 1-6; Second study
period 1 – 7 in group 2 .......................................................................................................................... 13
Table 2: The Abbreviated Injury Scale ................................... 16
Table 3: Injury Severity Score (ISS) ........................................................................ 17
Table 4: Patient Demographics ............................................. 19
Table 5: Mortality and need for ICU admission or major nonorthopedic operation according to TTA
criteria ................................................................................................................... 22
Table 6: ICU admissions within 24 hours according to ISS and TTA criteria ......................................... 22
Table 7: ICU admission and non-orthopaedic operations according to mechanism of injury and TTA
criteria ................................................................................................................................................... 24
Table 8: Data of Patients ≥ 70 years old and ISS >15 ........... 26
Table 9: Age ≥ 70 ye