Geriatric head injuries - Experience and expectations

2008 ◽  
Vol 05 (02) ◽  
pp. 69-73 ◽  
Author(s):  
VD Sinha ◽  
Vishnu Gupta ◽  
Deepak Kumar Singh ◽  
Sanjeev Chopra ◽  
Pankaj Gupta ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Head Injuries ◽  
The Elderly ◽  
Chronic Subdural Haematoma ◽  
Trauma Patients ◽  
Good Recovery ◽  
Family Ties ◽  
Global Citizenry ◽  
Careful Assessment ◽  
Close Family

AbstractIt is widely known that global citizenry is continuing to age. The elderly head trauma patients, comprising 4.83% in our series are important from neurosurgical aspects. We conducted a study of elderly head injury patients admitted to our unit in last 11 years. Out of 620 patients, 423 males and 197 female, constituting a ratio of 2.1∶1. Fall constitutes the principle mode of injury (56.29%) followed by RTA (44.1%). We analyzed all the cases for surgical intervention after careful assessment of neurological condition. Amongst all cases operated for acute trauma, good recovery was seen in 51.8% and mortality in 41.7%, whereas in chronic subdural haematoma 84.2% cases showed good recovery as against mortality in 10.5%. In our society, due to very close family ties and desperation of family members to try active intervention even in patients with expected bleak outcome, we operated a fairly large number of cases and concluded that outcome was better after operative intervention.

scholarly journals Use of atorvastatin on pacients with chronic subdural haematoma: an integrative review

2021 ◽  
Author(s):  
Nathan Isaac Grassi Evangelista ◽  
Matheus Antonio Traldi ◽  
Bianca de Oliveira Sousa ◽  
Emanuella Campaner Zanotti ◽  
Arthur Dal Fabbro Chocair ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Chronic Subdural Haematoma ◽  
Integrative Review ◽  
Neurological Deficits ◽  
Atorvastatin Treatment ◽  
Effect Of Treatment ◽  
The Common

Background: Chronic subdural hematoma (CSDH) tends to occur more commonly in elderly patients, usually develops after mild head trauma and the common treatment is surgical. Objective: To evaluate the effect of treatment with atorvastatin compared to surgical intervention in elderly people with CSDH. Design and setting: we performed an integrative review of studies available in four databases from 2010 to 2020. Methods: Studies were considered eligible for this review if they were randomized controlled trials comparing the use of atorvastatin treatment to surgical treatment associated with drainage trepanation in elderly patients diagnosed with CSDH. Results: titles and abstracts were screened and 20 articles of those were selected to be fully read, of which 4 remained. To Sheng Qui et al (2017) and Chan et al (2016), the use of atorvastatin may be beneficial in the management of CSDH, so that the volume of the hematoma reduced from 48.70 ± 20.38 to 16.64 ± 14.28mL with a sample size of 22 in the first month of oral atorvastatin. Min Xu et al. (2016) and Wang et al. (2013), with a sample of 22, found improvements in 85.7% and 95.7% of patients with CSDH in terms of volume and neurological deficits presented. Conclusion: The treatment with atorvastatin appears to be safe and effective for CSDH compared to surgical intervention in the elderly. However, further studies are necessary to validate the results and, thus, to put the evidence into practice.

Defining Hypotension in Moderate to Severely Injured Trauma Patients: Raising the Bar for the Elderly

2010 ◽  
Vol 76 (10) ◽  
pp. 1035-1038 ◽  
Author(s):  
Meghan Edwards ◽  
Eric Ley ◽  
James Mirocha ◽  
Anoushiravan Amini Hadjibashi ◽  
Daniel R. Margulies ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Los Angeles ◽  
Systolic Blood Pressure ◽  
Hemorrhagic Shock ◽  
Head Injuries ◽  
Age Groups ◽  
The Elderly ◽  
Trauma Patients ◽  
Severely Injured ◽  
Definition Of

Hypotension, defined as systolic blood pressure less than 90 mm Hg, is recognized as a sign of hemorrhagic shock and is a validated prognostic indicator. The definition of hypotension, particularly in the elderly population, deserves attention. We hypothesized that the systolic blood pressure associated with increased mortality resulting from hemorrhagic shock increases with increasing age. The Los Angeles County Trauma Database was queried for all moderate to severely injured patients without major head injuries admitted between 1998 and 2005. Several fit statistic analyses were performed for each systolic blood pressure from 50 to 180 mm Hg to identify the model that most accurately defined hypotension for three age groups. The optimal definition of hypotension for each group was determined from the best fit model. A total of 24,438 patients were analyzed. The optimal definition of hypotension was systolic blood pressure of 100 mm Hg for patients 20 to 49 years, 120 mm Hg for patients 50 to 69 years, and 140 mm Hg for patients 70 years and older. The optimal systolic blood pressure for improved mortality in hemorrhagic shock increases significantly with increasing age. Elderly trauma patients without major head injuries should be considered hypotensive for systolic blood pressure less than 140 mm Hg.

The G60 Trauma Center: A Future Consideration?

2017 ◽  
Vol 83 (6) ◽  
pp. 547-553 ◽  
Author(s):  
Marko Bukur ◽  
Joshua Simon ◽  
Joseph Catino ◽  
Margaret Crawford ◽  
Ivan Puente ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Trauma Center ◽  
Injury Severity ◽  
Head Injuries ◽  
Major Complication ◽  
The Elderly ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Failure To Rescue ◽  
Level I

With a considerably increasing elderly population, we sought to determine whether the volume of elderly trauma patients treated impacted outcomes at two different Level I trauma centers. This is a retrospective review of all elderly patients (>60 years) at two state-verified Level I trauma centers over the past five years. The elderly trauma center (ETC) saw a greater proportion (52%) of elderly patients than the reference trauma center (30%, TC). Demographic and clinical characteristics were abstracted and stratified into ETC and TC groups for comparison. Primary outcomes were overall postinjury complication and mortality rates, as well as death after major complication (failure to rescue). ETC patients were older (78.6 vs 70.5), more likely to be admitted with severe head injuries (head abbreviated injury score ≥ 3, 50.0% vs 32%), had a greater overall injury burden (injury severity score > 16 41.4% vs 21.1%), and required intensive care unit admission (81.3% vs 64%) than the TC group. Need for operative intervention, mechanism of injury, and comorbidities were similar between the two groups. Overall complications were higher in trauma patients admitted to the TC (21.9% vs 14.3%), as well as failure to rescue (4.0% vs 1.8%). Adjusting for confounding factors, ETC had significantly lower chance of developing a postinjury complication (adjusted odds ratios [AOR] = 0.4, 95% confidence interval [CI] = [0.3, 0.5]), failure to rescue (AOR = 0.3, 95% CI = [0.1, 0.5]), and overall mortality (AOR = 0.3, 95% CI = [0.2, 0.4]). Improved outcomes were demonstrated in the Level I center treating a higher proportion of elderly patients. Exact etiology of these benefits should be determined for quality improvement in care of the injured geriatric patient.

scholarly journals Geriatric head injuries: impact and outcomes

2019 ◽  
Vol 7 (9) ◽  
pp. 3461
Author(s):  
Vallabh B. Nagocha ◽  
Manish Yadav ◽  
Divyam Sharma ◽  
Sunil Garg
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Treatment Options ◽  
Head Injuries ◽  
Diffuse Axonal Injury ◽  
The Elderly ◽  
Trauma Patients ◽  
Post Injury ◽  
Factors Affecting ◽  
The Impact

Background: Elderly trauma patients present unique challenges and face  more  significant obstacles in  recovery  than  their younger  counterparts. They usually experience higher morbidity and mortality and slower recovery trajectories and have, on average, worse functional, cognitive, and psychosocial outcomes months or years post-injury than do younger patients.Methods: Authors conducted a study of elderly head injury patients to understand the epidemiology of geriatric TBI, the impact of comorbidities and management issues and  outcomes in such patients. Authors had a total of 110 patients who presented with traumatic brain injury and were admitted in this hospital over 2 years. Authors also reviewed the literatures to study the factors affecting outcome after geriatric TBI and studied the role of aggressive neurosurgical management in geriatric TBI.Results: Among 68%(n=75) of the patients were male and 32% females. Age group of 60-65 years was the highest with 60.9% patients. Patients with GCS of 8 and below had the highest mortality rates of 68 %. Overall  mortality  rate  was  32.72%  and  9.09 %  of  the patients survived in a vegetative condition. The proportion of injury secondary to fall was the largest single group in 50.9% patients, and Chronic SDH was the most common pathology seen in 36.45 % patients. Highest mortality was seen in patients with Diffuse Axonal Injury (69.23 %). Out of the 110 patients , 57 patients underwent surgery for various pathologies. Chronic SDH were the most common operated pathology followed by acute SDH. Glassgow outcome scale was used as the measure of outcome in these series of patients.  32.72 % patients had a GOS score of 1 and 9.09 % had a score of 2. 18.18 % patients remained severely disabled with a score of 3 and nine patients (8.18 %) had a score of 4 and thirty five patients had good recovery (GOS-5).Conclusions: Due to the better treatment options there is an increase in the number of elderly around the world. Thus, the number of eldery individuals presenting with TBI to the emergency department is also on the rise more commonly due to falls than road traffic accidents. There is a need for specific prognostic and management guidelines for the elderly which can lead to better diagnosis, care and recovery and eventual short- and long-term outcomes in the elderly.

Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽  
2021 ◽  
pp. 146040862098811
Author(s):  
Anith Nadzira Riduan ◽  
Narasimman Sathiamurthy ◽  
Benedict Dharmaraj ◽  
Diong Nguk Chai ◽  
Narendran Balasubbiah
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Surgical Intervention ◽  
Case Series ◽  
Trauma Patients ◽  
Lung Collapse ◽  
Comprehensive Management ◽  
Lung Capacity ◽  
Management Algorithm ◽  
Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

Experienced trauma team leaders save the lives of multiple-trauma patients with severe head injuries

Surgery Today ◽  
2018 ◽  
Vol 49 (3) ◽  
pp. 261-267
Author(s):  
Zhi-Jie Hong ◽  
Cheng-Jueng Chen ◽  
De-Chuan Chan ◽  
Teng-Wei Chen ◽  
Jyh-Cherng Yu ◽  
...  
Keyword(s):  
Multiple Trauma ◽  
Head Injuries ◽  
Trauma Team ◽  
Trauma Patients ◽  
Team Leaders ◽  
Multiple Trauma Patients

scholarly journals Spontaneous resolution of large non-traumatic bilateral acute-on-chronic subdural hematoma

2017 ◽  
Vol 31 (1) ◽  
pp. 8-16
Author(s):  
D. Adam ◽  
D. Iftimie ◽  
Gina Burduşa ◽  
Cristiana Moisescu
Keyword(s):  
Conservative Treatment ◽  
Subdural Hematoma ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Neurological Status ◽  
Spontaneous Resolution ◽  
Subdural Hematomas ◽  
Gcs Score

Abstract Background and importance: Chronic subdural hematomas are a frequently encountered neurosurgical pathology, especially in the elderly. They often require surgical evacuation, but recent studies have shown good results with conservative treatment in selected cases. Clinical presentation: We report the case of a 72-year old patient that developed large, non-traumatic, bilateral, acute-on-chronic subdural hematoma after repeated abdominal surgery for appendicular carcinoma. He presented an abdominal wound infection and good neurological status (GCS score of 14 points), factors that indicated the delay of surgical intervention. Subsequent clinical and radiological improvement forestalled the operation altogether and he presented complete spontaneous resolution of subdural hematomas at only 5 months after diagnosis. Conclusion: Although surgical treatment is performed in the majority of chronic subdural hematomas, in clinically and radiologically selected cases, the operation can be avoided. The hematoma can present resolution, either spontaneously or with the help of conservative treatment.

scholarly journals Individual Pharmacotherapy Management (IPM) - I: a group-matched retrospective controlled clinical study on prevention of complicating delirium in the elderly trauma patients and identification of associated factors

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Luise Drewas ◽  
Hassan Ghadir ◽  
Rüdiger Neef ◽  
Karl-Stefan Delank ◽  
Ursula Wolf
Keyword(s):  
Clinical Study ◽  
Associated Factors ◽  
Intervention Group ◽  
The Elderly ◽  
Control Group ◽  
Trauma Patients ◽  
Effective Prevention ◽  
Multivariable Regression ◽  
Elderly Trauma Patients ◽  
Controlled Clinical Study

Abstract Background Delirium is one of the most frequent complications in hospitalized elderly patients with additional costs such as prolongation of hospital stays and institutionalization, with risk of reduced functional recovery, long-term cognitive impairment, and increased morbidity and mortality. We analyzed the effect of individual pharmacotherapy management (IPM) in the University Hospital Halle in geriatric trauma patients on complicating delirium and aimed to identify associated factors. Methods In a retrospective controlled clinical study of 404 hospitalized trauma patients ≥70 years we compared the IPM intervention group (IG) with a control group (CG) before IPM implementation. Delirium was recorded from the hospital discharge letter. The medication review and data records included baseline data, all medications, diagnoses, electrocardiogram (ECG), laboratory and vital parameters during hospitalization. The IPM internist and the senior trauma physician guaranteed personnel and structural continuity in the implementation of the interdisciplinary patient rounds. Results There was a highly matched congruence between CG and IG in terms of age, gender, residency, BMI, most diagnoses, and injury patterns to compare the two groups. The total number of medications per patient was 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG). Our targeted IPM focus on 6 frontline aspects with reduction of antipsychotics, anticholinergic burden, benzodiazepines, serotonergic opioids, elimination of pharmacokinetic and pharmacodynamic drug interactions and overdosage reduced complicating delirium from 5% to almost zero at 0.5%. The association of IPM with a significant 10-fold reduction, OR = 0.09 [95% CI 0.01–0.7], in univariable regression, maintained of clinical relevance in multivariable regression OR = 0.1 [95% CI 0.01–1.1]. Factors most strongly associated with complicating delirium in univariable regression were cognitive dysfunction, nursing home residency, muscle relaxants, antiparkinsonian agents, xanthines, transient disorientation documented in the fall risk scale, antibiotic-requiring infections, antifungals, antipsychotics, and intensive care stay, the two latter maintaining significance in multivariable regression. Conclusions IPM is associated with a highly effective prevention of complicating delirium in the elderly trauma patients. For patient safety it should be integrated as an essential preventative contribution. The associated factors help identify patients at risk.

scholarly journals One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center

2020 ◽  
Vol 40 (4) ◽  
pp. 298-304
Author(s):  
Khalid A. Alsheikh ◽  
Firas M. Alsebayel ◽  
Faisal Abdulmohsen Alsudairy ◽  
Abdullah Alzahrani ◽  
Ali Alshehri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Mortality Rate ◽  
Hip Fractures ◽  
Surgical Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
The Elderly ◽  
Tertiary Care Center ◽  
Factors Associated ◽  
One Year

ABSTRACT BACKGROUND: Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications. OBJECTIVES: Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality. DESIGN: Medical record review. SETTING: Tertiary care center. PATIENTS AND METHODS: All patients 60 years of age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files. MAIN OUTCOME MEASURES: The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality. SAMPLE SIZE: 802 patients. RESULTS: The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications ( P =.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures. LIMITATION: Single-centered study. CONFLICT OF INTEREST: None.

scholarly journals Characteristics of geriatric neurology patients treated at the central hospital of Sanglah Denpasar in 2019

2020 ◽  
Vol 7 (2) ◽  
pp. 245
Author(s):  
Stephanie Elizabeth Gunawan ◽  
Anak Agung Ayu Putri Laksmidewi
Keyword(s):  
Medical Records ◽  
Elderly Population ◽  
Neurological Diseases ◽  
Head Injuries ◽  
Elderly Person ◽  
The Elderly ◽  
World Health ◽  
Central Hospital ◽  
The World ◽  
Health Organization

Background: According to the World Health Organization (WHO), an elderly person is someone who has entered the age of 60 years and above whose percentage tends to increase along with decreasing morbidity of the elderly. Geriatric Neurology itself is the study of a group of neurological diseases in the elderly. Based on 2012 data, the proportion of elderly population in Indonesia is 7.59%. This is accompanied by an increase in the dependency ratio of the productive age population to the non-productive age population. The results of the 2013 Basic Health Research showed an increase in the prevalence of neurological disease in the elderly which was the main cause of death in 15 regencies in 2011. It is to find out the 5 most neurological diseases in the elderly, clinical characteristics and outcomes of geriatric neurology patients treated at the Central Hospital of Sanglah.Methods: It is a retrospective study using no control by looking at medical records in geriatric neurology patients aged 60 years and over who visited the Central Hospital of Sanglah in the March to May 2019 period.Results: A total of 200 patients consisted of 111 men (55.5%) and 89 women (44.5%) who were divided into 5 most geriatric neurology diseases which included 1. ischemic stroke, 2. bleeding stroke, 3. brain tumor, 4. injury head, and 5. epilepsy. The number of deaths was 16, of which 7 cases were caused by sepsis and pneumonia.Conclusions: Stroke, tumors, head injuries and epilepsy are the dominant neurological diseases found. The focus of care and supervision of elderly neurology patients is expected to be further enhanced to prevent side effects that will extend the patient’s treatment period in the hospital which will automatically increase the burden on the hospital itself.

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