Comment on “The psoas muscle index as a predictor of mortality and morbidity of geriatric trauma patients: experience of a major trauma center in Kobe.”

Abstract Background There is an emerging role for the radiological evaluation of the psoas muscle as a marker of sarcopenia, and as a prognostic discriminant in elderly patients with traumatic injuries. Older trauma patients are more likely to undergo cranial than abdomino-pelvic imaging. Identifying sarcopenia using masseter cross sectional area (M-CSA) has shown correlation with mortality. We sought to determine the correlation between psoas: lumbar vertebral index (PLVI) and the M-CSA, and their association with health outcomes. Methods Patients aged 65 or above, who presented as a trauma call over a 1 year period were included if they underwent cranial or abdominal CT imaging. Images were retrospectively analyzed to obtain PLVI and mean M-CSA measurements. Electronic records were abstracted for demographics and outcomes. Logistic regression methods, log scale analyses, Cox regression model and Kaplan-Meier plots were used to determine association of sarcopenia with outcomes. Results There were 155 eligible patients in the M-CSA group and 204 patients in the PLVI group. Sarcopenia was defined as the lowest quartile in each group. Both PLVI and M-CSA measurements were available in 142 patients. Pearson’s correlation indicated a weakly positive linear relationship (r = 0.35, p < 0.001) between these. There was no statistical association between M-CSA sarcopenia status and any measured outcomes. Those with PLVI sarcopenia were more likely to die in hospital (adjusted OR 3.38, 95% CI 1.47–9.73, p = 0.006) and at 2-years (adjusted HR 1.90, 95% CI 1.11–3.25, p = 0.02). Only 29% patients with PLVI sarcopenia were discharged home, compared with 58% without sarcopenia (p = 0.001). Conclusion Sarcopenia, defined by PLVI, is predictive of increased in-patient and 2- year mortality. Our study did not support prognostic relevance of M-CSA. Further research should be directed at improving the validity of masseter measurements or identifying alternative radiological determinants of sarcopenia on cranial imaging.

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Suburban geriatric trauma: the experiences of a level I trauma center

American Journal of Critical Care ◽

10.4037/ajcc1995.4.5.379 ◽

1995 ◽

Vol 4 (5) ◽

pp. 379-382 ◽

Cited By ~ 9

Author(s):

F DeKeyser ◽

D Carolan ◽

A Trask

Keyword(s):

Trauma Center ◽

Functional Outcomes ◽

Injury Severity ◽

The Elderly ◽

Mortality Rates ◽

Geriatric Trauma ◽

Trauma Patients ◽

Younger Patients ◽

Severity Scores ◽

Trauma Scores

BACKGROUND: As the mean age of the US population increases, so does the incidence of geriatric trauma. Investigators have shown that the elderly have high morbidity and mortality rates associated with traumatic injuries. OBJECTIVE: To compare the severity of injury, mortality, and functional outcomes of geriatric patients with younger patients admitted to a suburban trauma center. METHOD: A convenience sample of trauma patients who were 65 years old or older was compared with trauma patients who were 35 to 45 and 55 to 64 years old. Demographic data, injury data, Injury Severity Scores, Revised Trauma Scores, length of stay, and functional ability outcomes were abstracted from a trauma registry in aggregate form and then analyzed. RESULTS: The sample consisted of 766 subjects (age 35-45, n = 223; age 55-64, n = 135; age 65 and older, n = 408) with a mean age of 64.6 years. A larger percentage of the elderly were victims of falls; younger trauma patients were more likely to be victims of motor vehicle crashes. Significant differences were found between age groups on Glasgow Coma Scale scores. Revised Trauma Scores, and length of stay. Significant differences were not found on Injury Severity Scores, mortality rates, or functional outcomes. CONCLUSIONS: Although anatomic injury severity of elderly patients was similar to that of younger patients, the elderly demonstrated greater physiologic compromise and longer hospital stays. Mortality rates were lower for the elderly group, but this result might be because a larger proportion of elderly patients were hospitalized with minor or moderate injuries.

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The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19004825 ◽

2019 ◽

Vol 34 (05) ◽

pp. 497-505

Author(s):

Matthew H. Meyers ◽

Trent L. Wei ◽

Julianne M. Cyr ◽

Thomas M. Hunold ◽

Frances S. Shofer ◽

...

Keyword(s):

Older Adults ◽

Trauma Center ◽

Medical Information ◽

Geriatric Trauma ◽

Medical Information System ◽

Trauma Patients ◽

Glascow Coma Scale ◽

Serious Injury ◽

Gcs Score ◽

The Impact

AbstractIntroduction:In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.Hypothesis/Problem:The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.Methods:This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.Results:The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.Conclusions:State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.

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The accuracy of focused assessment with sonography in trauma (FAST) in blunt trauma patients: Experience of an Australian major trauma service

Injury ◽

10.1016/j.injury.2006.03.004 ◽

2007 ◽

Vol 38 (1) ◽

pp. 71-75 ◽

Cited By ~ 27

Author(s):

Jeremy M. Hsu ◽

Anthony P. Joseph ◽

Lisa J. Tarlinton ◽

Lewis Macken ◽

Steven Blome

Keyword(s):

Blunt Trauma ◽

Major Trauma ◽

Trauma Patients ◽

Trauma Service ◽

Patients Experience

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Pre-hospital use of intravenous in-line fluid warmers to reduce morbidity and mortality for major trauma patients: A review of the current literature.

Australasian Journal of Paramedicine ◽

10.33151/ajp.12.2.139 ◽

2015 ◽

Vol 12 (2) ◽

Author(s):

Nicholas Collins ◽

Stuart Daly ◽

Patricia Johnson ◽

Gavin Smith

Keyword(s):

Patient Outcomes ◽

Major Trauma ◽

Hospital Setting ◽

Morbidity And Mortality ◽

Trauma Patients ◽

Hospital Emergency ◽

Mortality And Morbidity ◽

Poor Patient ◽

Patient Morbidity ◽

Lethal Triad

IntroductionIn-line fluid warmers are an established treatment for delivering warmed intravenous (IV) fluid in the hospital setting. Recently their potential application within the pre-hospital setting has been highlighted to potentially reduce mortality and morbidity. Currently ambulance paramedics only administer warmed fluid to patients assessed as hypothermic, and this fluid is subject to further cooling on exposure to ambient environmental conditions. This review examined the peer-reviewed literature to determine the available evidence for in-line fluid warmer effectiveness and potential inclusion in pre-hospital emergency care.MethodsA review of the electronic literature, including the Medline and Ebscohost databases was conducted using the terms “intravenous fluid warmers” “hypothermia”, “ trauma”, “ fluid”, “coagulopathy”, “ acidosis”, “hypothermia and trauma patients”, “accidental hypothermia”, “lethal triad” and “trauma care”. Articles were included if they represented a study of in-line fluid warmers within the surgical, general hospital or pre-hospital emergency care settings. Articles not available in English or as full text were excluded.ResultsThe review identified 23 relevant articles for analysis. Of note, up to 40% of trauma patients with signs of hypoperfusion were reported to arrive at hospital in a hypothermic state post-incident. Hypothermia plays a significant role in contributing to the ‘triad of death’- a condition that results in poor patient outcomes and high mortality rates.ConclusionThis review identified that current pre-hospital practice does not prescribe warmed fluid to the normothermic trauma patient. The review also identified that there is a need for in-line fluid warmers in ambulance practice to prevent or limit hypothermia and reduce patient morbidity and mortality associated with trauma.

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Evidence-based review of trauma center care and routine palliative care processes for geriatric trauma patients; A collaboration from the American Association for the Surgery of Trauma Patient Assessment Committee, the American Association for the Surgery of Trauma Geriatric Trauma Committee, and the Eastern Association for the Surgery of Trauma Guidelines Committee

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002155 ◽

2019 ◽

Vol 86 (4) ◽

pp. 737-743 ◽

Cited By ~ 6

Author(s):

Hiba Abdel Aziz ◽

John Lunde ◽

Robert Barraco ◽

John J. Como ◽

Zara Cooper ◽

...

Keyword(s):

Palliative Care ◽

Trauma Center ◽

American Association ◽

Geriatric Trauma ◽

Evidence Based ◽

Trauma Patients ◽

Patient Assessment ◽

Care Processes ◽

Center Care ◽

Assessment Committee

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The Prevalence of Beers Criteria Medication Use and Associations with Falls in Geriatric Patients at a Level 1 Trauma Center

The American Surgeon ◽

10.1177/000313481908500842 ◽

2019 ◽

Vol 85 (8) ◽

pp. 877-882 ◽

Cited By ~ 1

Author(s):

Benjamin S. Walker ◽

Bryan R. Collier ◽

Katie L. Bower ◽

Daniel I. Lollar ◽

Emily R. Faulks ◽

...

Keyword(s):

Trauma Center ◽

Fall Risk ◽

Medication Reconciliation ◽

Geriatric Patients ◽

Medication Use ◽

Geriatric Trauma ◽

Beers Criteria ◽

Trauma Patients ◽

Level 1 ◽

Level 1 Trauma Center

The Beers Criteria for Potentially Inappropriate Medication (PIM) use is a list of medications with multiple risks in older patients. Approximately 24 per cent use rate is reported in prior studies. Our objective was to determine the local PIM use and subsequent fall risk in geriatric trauma patients. We conducted a retrospective analysis of PIM use in all geriatric patients evaluated at our Level 1 trauma center between 2014 and 2017. Patients were identified from our trauma database. Pre-admission medication use was determined through medication reconciliation from our electronic medical record (EMR). Patients not undergoing medication reconciliation were excluded. After initial analysis, patients were stratified by age into three groups: 65 to 74, 75 to 84, and ≥85 years. Multivariate logistic regression analyses were used to calculate odds ratios of falls for specific PIMs. In all, 2181 patients met the inclusion criteria. Overall, 71.2 per cent of geriatric trauma patients were prescribed at least one PIM—73.1 per cent of falls compared with 68.6 per cent for other mechanisms. Specific PIM use varied by age group. PIMs associated with fall risk in all patients included antipsychotics, benzodiazepines, and diclofenac. For those aged 65 to 74 years, antihistamines, diclofenac, proton pump inhibitors, and promethazine were associated. In those aged 75 to 84 years, alprazolam, antipsychotics, benzodiazepines, cyclobenzaprine, diclofenac, and muscle relaxants were implicated. No significant associations were found for patients aged ≥85 years. PIM use at our trauma center seems to be rampant and well above the national average. Geriatric falls were associated with using ≥1 PIM and multiple specific PIMs implicated. We are designing a targeted educational program for local primary care physicians (PCPs) that will attempt to decrease geriatric PIM use.

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