scholarly journals Do Entrapment, Injuries, Outcomes and Potential for Self-extrication Vary with Age? A Pre-specified Analysis of the UK Trauma Registry (TARN)

2021 ◽  
Author(s):  
Tim Nutbeam ◽  
Anthony Kehoe ◽  
Rob Fenwick ◽  
Jason Smith ◽  
Omar Bouamra ◽  
...  
Keyword(s):  
Older Patients ◽  
Motor Vehicle ◽  
Descriptive Analysis ◽  
Age Groups ◽  
Research Network ◽  
Age Group ◽  
Spinal Movement ◽  
Increased Risk ◽  
Limb Injuries ◽  
The Uk

Abstract Background:Motor vehicle collisions (MVCs), particularly those associated with entrapment, are a common cause of major trauma. Current extrication methods are focused on spinal movement minimisation and mitigation, but for many patients’ self-extrication may be an appropriate alternative. Older drivers and passengers are increasingly injured in MVCs and may be at an increased risk of entrapment and its deleterious effects. The aim of this study is to describe the injuries, trapped status, outcomes, and potential for self-extrication for patients following an MVC across a range of age groups. Methods:This is a retrospective study using the Trauma Audit and Research Network (TARN) database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2019. Patients were excluded when their outcomes were not known or if they were secondary transfers. Simple descriptive analysis was used across the age groups: 16-59, 60-69, 70-79 and 80+ years. Logistic regression was performed to develop a model with known confounders, considering the odds of death by age group, and examining any interaction between age and trapped status with mortality. Results:70,027 patients met the inclusion criteria. Older patients were more likely to be trapped and to die following an MVC (p<0.0001). Head, abdominal and limb injuries were more common in the young with thoracic and spinal injuries being more common in older patients (all p<0.0001). No statistical difference was found between the age groups in relation to ability to self-extricate. After adjustment for confounders, the 80+ age group were more likely to die if they were trapped; adjusted OR trapped 30.2 (19.8 - 46), not trapped 24.2 (20.1 - 29.2). Conclusions:Patients over the age of 80 are more likely to die when trapped following an MVC. Self-extrication should be considered the primary route of egress for patients of all ages unless it is clearly impracticable or unachievable. For those patients who cannot self-extricate, a minimally invasive extrication approach should be employed to minimise entrapment time.

scholarly journals The Effect of Serum Sodium on Survival in Patients Treated by Peritoneal Dialysis in the United Kingdom

2017 ◽  
Vol 37 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Asmaa Al-Chidadi ◽  
Dorothea Nitsch ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Sodium ◽  
Cox Regression ◽  
Strong Association ◽  
Age Groups ◽  
Older Age ◽  
Age Group ◽  
Younger Age ◽  
Increased Risk ◽  
The Uk

Background Studies in hemodialysis patients suggest that hyponatremia is associated with increased mortality. However, results from peritoneal dialysis (PD) patients are discordant. We wished to establish whether there was an association between serum sodium and mortality risk in PD patients. Methods We analyzed 3,108 PD patients enrolled at day 90 of renal replacement therapy (RRT) into the UK Renal Registry (UKRR) data base with available serum sodium measurements (in 3 groups: ≤ 137, 138 - 140, ≥ 141 mmol/L) who were then followed up until death or the censoring date (31 December 2012). Analysis used Cox-regression with adjustment for age, sex, year of starting RRT, primary renal disease, serum albumin, smoking, and comorbidities. Results Unadjusted mortality rates were 118.6/1,000 person-years (py), 83.4/1,000 py, and 83.5/1,000 py for the lowest, middle, and highest serum sodium tertiles, respectively. After adjustment for covariates, patients in the lowest serum sodium group had almost 50% increased risk of dying compared with those with the highest serum sodium (hazard ratio [HR] 1.49, confidence interval [CI]:1.28 - 1.74), with a graded association between serum sodium and mortality. The association of serum sodium with mortality varied by age (p interaction < 0.001), and whilst this association attenuated after adjustment for confounding variables in the older age groups (55 - 64, and > 65 years), it remained in the younger age group of 18 - 54 years (HR 2.24 [1.36 – 3.70] in the lowest compared with the highest sodium tertile). Conclusions Lower serum sodium concentrations at the start of RRT in PD patients are associated with increased risk of mortality. Whilst this association may well be due to confounding in the older age groups, the persistent strong association between hyponatremia and mortality in the younger age group after adjustment for the available confounders suggests that prospective studies are required to assess whether active intervention to maintain serum sodium changes outcomes.

Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse?

1996 ◽  
Vol 85 (3) ◽  
pp. 410-418 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Neal F. Kassell ◽  
Teresa P. Germanson ◽  
Gail L. Kongable ◽  
Laura L. Truskowski ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Subarachnoid Hemorrhage ◽  
Age Groups ◽  
Age Group ◽  
Content Type ◽  
Poor Outcome ◽  
Symptomatic Vasospasm ◽  
Age Related ◽  
Increased Risk ◽  
Fine Print

✓ Advanced age is a recognized prognostic indicator of poor outcome after subarachnoid hemorrhage (SAH). The relationship of age to other prognostic factors and outcome was evaluated using data from the multicenter randomized trial of nicardipine in SAH conducted in 21 neurosurgical centers in North America. Among the 906 patients who were studied, five different age groups were considered: 40 years or less, 41 to 50, 51 to 60, 61 to 70, and more than 71 years. Twenty-three percent of the individuals enrolled were older than 60 years of age. Women outnumbered men in all age groups. Level of consciousness (p = 0.0002) and World Federation of Neurological Surgeons grade (p = 0.0001) at admission worsened with advancing age. Age was also related to the presence of a thick subarachnoid clot (p = 0.0001), intraventricular hemorrhage (p = 0.0003), and hydrocephalus (p = 0.0001) on an admission computerized tomography scan. The rebleeding rate increased from 4.5% in the youngest age group to 16.4% in patients more than 70 years of age (p = 0.002). As expected, preexisting medical conditions, such as diabetes (p = 0.028), hypertension (p = 0.0001), and pulmonary (p = 0.0084), myocardial (p = 0.0001), and cerebrovascular diseases (p = 0.0001), were positively associated with age. There were no age-related differences in the day of admission following SAH, timing of the surgery and/or location, and size (small vs. large) of the ruptured aneurysm. During the treatment period, the incidence of severe complications (that is, those complications considered life threatening by the reporting investigator) increased with advancing age, occurring in 28%, 33%, 36%, 40%, and 46% of the patients in each advancing age group, respectively (p = 0.0002). No differences were observed in the reported frequency of surgical complications. No age-related differences were found in the overall incidence of angiographic vasospasm; however, symptomatic vasospasm was more frequently reported in the older age groups (p = 0.01). Overall outcome, assessed using the Glasgow Outcome Scale at 3 months post-SAH, was poorer with advancing age (p < 0.001). Multivariate analysis of overall outcome, adjusting for the different prognostic factors, did not remove the age effect, which suggests that the aging brain has a less optimal response to the initial bleeding. Age as a risk factor is a continuum; however, there seems to be a significant increased risk of poor outcome after the age of 60 years.

Abstract 14804: Complications and Mortality Following CRT-D versus ICD Implants in Older Medicare Beneficiaries

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emily P Zeitler ◽  
Andrea Austin ◽  
Daniel J Friedman ◽  
Christopher G Leggett ◽  
Lauren Gilstrap ◽  
...  
Keyword(s):  
Lower Risk ◽  
Older Patients ◽  
Proportional Hazards Model ◽  
Age Groups ◽  
Cox Proportional Hazards Model ◽  
Cardiac Resynchronization ◽  
Age Group ◽  
Medicare Beneficiaries ◽  
Icd Implantation ◽  
Risk Of Death

Introduction: Despite growing numbers of older HF patients, clinical trials of implantable defibrillators (ICDs) and cardiac resynchronization therapy (CRT) rarely include older patients (≥75 yrs). Hypotheses: (1) Among Medicare beneficiaries, older CRT-D patients have a higher risk of procedure-related complications than older ICD patients. (2) Compared with older ICD patients, older CRT-D patients have lower risk of death. Methods: We identified Medicare beneficiaries with HF and reduced LVEF who underwent ICD or CRT-D implant based on CPT codes (1/2008-8/2015) by age group (65-74, 75-84, and 85+). After matching device groups with inverse probability weighting (IPW), we estimated the comparative hazard ratio (HR) of death by age group and device type using a Cox proportional hazards model. Results: Compared with the ICD group, the CRT-D group was older and more likely to be white and female and have atrial fibrillation; CRT-D patients were less likely to have ischemic heart disease. Use of guideline directed medical therapy was similar between groups. In all age groups, complications were more common in the CRT-D group. IPW was successful, and after matching, the HR for death was lower in the CRT-D versus the ICD group; this finding was most pronounced in the 85+ age group in which the HR for death in the CRT-D versus ICD group was 0.76 (95% CI 0.64-0.88). (Table) Conclusions: Procedure-related complications in older HF patients were higher in CRT-D versus ICD patients and generally increased with age. Overall high post-implant mortality in ICD patients (± CRT) highlights the difficulty in assessing competing mortality risk when considering patients for an ICD especially in the oldest patients in whom clinical trial data are absent. However, in matched Medicare beneficiaries, CRT-D was associated with a lower risk of mortality in all age groups compared with ICD alone. These findings support the use of CRT in eligible older patients undergoing ICD implantation.

scholarly journals P0559AKI SEASONALITY IN ENGLAND

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Esther Wong ◽  
Dorothea Nitsch
Keyword(s):  
Cox Regression ◽  
Winter Season ◽  
Kidney Injury ◽  
Seasonal Effect ◽  
Winter Mortality ◽  
Age Group ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

Abstract Background and Aims Incidence of Acute Kidney Injury (AKI) is known to be seasonal, peaking in winter months among hospitalised patients. Previous studies have suggested that the seasonality of AKI is likely to be influenced by the seasonality of the underlying acute illnesses that are associated with AKI. Mortality of patients with AKI has also been reported as being higher in winter, reflecting well-described excess winter mortality associations. Here we describe the seasonal variations of AKI alerts in England and the associated mortality rate using linked national databases. Method Serum creatinine changes compatible with KDIGO AKI stage 1, 2 and 3 are sent by laboratories in England as AKI alerts to the treating clinicians and the UK Renal Registry (UKRR). We linked the electronic AKI alerts to the Hospital Episode Statistics (HES) data, to identify patients who were hospitalised. We carried out descriptive statistics, and investigate the seasonal effect to the 30-day patient mortality from date of getting AKI alert, using multivariable Cox regression and sequentially adjusting for age, sex, Index of multiple deprivation (IMD) and peak AKI stage Results Winter has the highest number of AKI episodes (N=81,276), which is 6% higher than that in summer (N=76,329) (Table 1). For patients who had an AKI episode and admitted to hospitals, the crude 30-day mortality is higher in the winter season when compared to the summer [HR 1.28 (1.25-1.31), p&lt;0.01] (Figure 1). After adjusting season by age, peak AKI stage, IMD and sex, winter season still has significantly higher 30-day mortality than summer [HR 1.24 (1.21-1.27), p&lt;0.01]. Winter mortality peak is confounded by age and AKI severity, which explained the drop of hazard ratio at winter peaks; whereas season is not confounded by deprivation and sex. The pattern of seasonality varies with age, in age group 18-39, there were 26.1% of AKI episodes in summer and 23.3% in winter, whereas in age group &gt;75, there were 23.7% in summer and 27.1% in winter. Conclusion Analysis of England data confirms seasonal peak in AKI during winter months. Additionally it shows increased risk of mortality for patients with AKI in winter months. Future work will investigate the impact of comorbidities and case-mix on outcomes. By understanding the seasonal variation of AKI, we can potentially plan preventive care and improve clinical practice.

scholarly journals Difference in declarative tactical knowledge between U-11 and U-15 soccer players

2017 ◽  
Vol 18 (5) ◽  
Keyword(s):  
Statistical Analysis ◽  
Descriptive Analysis ◽  
Age Groups ◽  
Verbal Report ◽  
Soccer Players ◽  
Age Group ◽  
Simulation Test ◽  
Significance Level ◽  
Practice Time ◽  
Tactical Knowledge

AbstractPurpose. The aim of this study was to compare the level of declarative tactical knowledge between U-11 and U-15 academy players. Methods. The sample comprised 36 U-11 (n = 18) and U-15 (n = 18) soccer players, with practice time of 1404.00 ± 469.52 hours and 2663.55 ± 594.91 hours, respectively. The players’ practice time was collected through a recording questionnaire. Declarative tactical knowledge was assessed through a verbal report used during a video simulation test. The answers provided during the test were scored as follows: best solution (1 point); second best solution (0.75 points); third best solution (0.50 points); fourth best solution (0.25 points); wrong solution (0 points). For statistical analysis, descriptive analysis was performed, as well as the Shapiro-Wilk and Mann-Whitney tests, with significance level set at p < 0.05. For statistical purposes, the SPSS 22.0 software was applied. Results. Significant differences were observed in declarative tactical knowledge between the U-11 and U-15 age groups. Players of the older age group displayed longer practice time and higher scores than their younger counterparts. Conclusions. Players with longer practice time (U-15) possess greater declarative tactical knowledge than those with less practice time (U-11), and declarative tactical knowledge is a factor that differentiates soccer players aged 11 and 15 years.

103 Screening for Alcohol and Drugs: Are We Under-testing Older Patients?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S67-S68
Author(s):  
Alisa Savetamal ◽  
Timothy Burton ◽  
Brittany Davis ◽  
Samantha Wenta
Keyword(s):  
High Risk ◽  
Older Patients ◽  
Drugs Of Abuse ◽  
Alcohol Intoxication ◽  
Age Groups ◽  
Burn Patients ◽  
Age Group ◽  
Alcohol And Drugs ◽  
Drug And Alcohol ◽  
Substances Of Abuse

Abstract Introduction Only a fraction of trauma patients are being tested for drugs of abuse, despite the evidence that abuse of these substances contributes to traumatic injuries. In the specific trauma patient population of burn victims, drug and alcohol intoxication at the time of the burn may alter prognosis for both morbidity and mortality. Younger populations tend to be thought of at higher risk for drug and alcohol intoxication, and this may bias testing in other age groups. This study examined drug and alcohol testing in burn patients presenting to an ABA-verified burn center to determine if testing biases existed based on age, sex, or burn severity, and what populations were high risk for abuse in order to optimize testing in the high risk populations. Methods The burn center’s inpatient database was queried for all admitted patients from January 2013 to December 2017. Patients whose charts lacked description of the burns or where no burn information could be found were excluded from the study. Age, sex, length of stay (LOS), and total body surface area (TBSA) burned were examined. Statistical analysis was then performed with t-tests and Fisher’s test. Results A total of 1032 patients were included in the study. 159 (15.4%) patients were tested for alcohol use and 146 (14.1%) were tested for drugs. Significant predictors of whether patients were tested or not were TBSA and LOS (P&lt; 0.001 for both). There were no significant differences between sexes in testing positive for drugs or alcohol, although there was a trend for more aggressive screening in males than females. The age group most likely to test positive for drugs and/or alcohol was 51–60 year olds. This age group accounted for 25% and 20% of all burn patients tested for alcohol and substances of abuse, respectively; yet this group accounted for 53% and 23% of all positive alcohol and drug tests. Perhaps surprisingly, individuals in age groups up to 90s tested positive for both alcohol and drugs. Conclusions As expected, age extremes were not tested for drugs or alcohol. Only 15% of patients were screened on arrival. Of these and contrary to expectations, 51–60 year olds were the most likely group of burn patients to test positive for drugs and/or alcohol, and patients up to their 90s were testing positive for substances of abuse. However, these populations are not as rigorously screened as younger populations and the use of these substances may be missed, thus affecting patient outcomes. Age bias may be limiting screening and affecting care in older burn patient populations. Applicability of Research to Practice Older patients (51–60 year olds) when tested are more likely to test positive particularly for alcohol upon presentation. More rigorous testing of older patients for alcohol and drugs of abuse may capture more patients who are using these substances and help to guide early care in these populations.

scholarly journals Pancreatic Surgery in the Older Population: A Single Institution’s Experience over Two Decades

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Bhaumik Brahmbhatt ◽  
Abhishek Bhurwal ◽  
Frank J. Lukens ◽  
Mauricia A. Buchanan ◽  
John A. Stauffer ◽  
...  
Keyword(s):  
Pancreatic Resection ◽  
Care Center ◽  
Tertiary Care ◽  
Age Groups ◽  
The Elderly ◽  
Age Group ◽  
Pancreatic Resections ◽  
Increased Risk ◽  
Younger Patient ◽  
Two Age Groups

Objectives. Surgery is the most effective treatment for pancreatic cancer. However, present literature varies on outcomes of curative pancreatic resection in the elderly. The objective of the study was to evaluate age as an independent risk factor for 90-day mortality and complications after pancreatic resection. Methods. Nine hundred twenty-nine consecutive patients underwent 934 pancreatic resections between March 1995 and July 2014 in a tertiary care center. Primary analyses focused on outcomes in terms of 90-day mortality and postoperative complications after pancreatic resection in these two age groups. Results. Even though patients aged 75 years or older had significantly more postoperative morbidities compared with the younger patient group, the age group was not associated with increased risk of 90-day mortality after pancreatic resection. Discussion. The study suggests that age alone should not preclude patients from undergoing curative pancreatic resection.

An International Comparison Of Survival Disparities In Patients With Lymphoma and Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2925-2925
Author(s):  
Dianne Pulte ◽  
Theresa Redaniel ◽  
Mona Jeffreys
Keyword(s):  
Older Patients ◽  
Excess Mortality ◽  
Conflicts Of Interest ◽  
Relative Survival ◽  
The United States ◽  
Life Tables ◽  
Younger Patients ◽  
Increased Risk ◽  
The Us ◽  
The Uk

Abstract Background Relative survival in older patients with lymphomas is significantly lower than in younger patients. Possible reasons for the discrepancy may include increased aggressiveness of the disease in older patients, increased frailty and co-morbidities complicating treatment in older patients, and under-treatment of older patients due to concern about increased risk of intolerance to treatment. Distinguishing between these problems on a population basis can be difficult as clinical trial data often provides data only on the “ideal” patient and may not be applicable to the general population. Here, we determine 5-year relative survival and excess mortality by age for patients diagnosed with Hodgkin's lymphoma (HL), non-Hodgkin lymphoma (NHL) and multiple myeloma. Methods Data was obtained from the Surveillance, Epidemiology, and End Results (SEER) database in the United States (US) and Cancer Registry data covering the whole of England (UK) for all patients diagnosed with HL, NHL and myeloma between 1996 and 2010. Five year relative survival was calculated by categories of age (15-24; 25-44; 45-64; 65-74 and 75+ years) using period analysis. Relative survival was calculated using age, race, gender, and country specific life tables. In addition, region specific life tables were used in the UK. Excess mortality modellingwas used to determine excess risk for older compared to younger patients, using patients age 25-44 for the reference group. Results Five year relative survival was lower for older patients diagnosed with HL, NHL, and myeloma in the US and UK. The most dramatic difference in survival by age was observed for patients with HL among whom survival for 15-24 year olds was 96.2% and 92.5% in 2006-10 in the US and UK, respectively but only 51.0% and 22.8%, respectively, for patients age 75+, representing an excess mortality of 14.02 (95% CI 12.22-16.09) and 15.69 (14.21-17.33), respectively, for the US and UK for patients age 75+ compared to 25-44. Similar, although less extreme, differences were observed for NHL and myeloma (see Table). Excess mortality ratios of 1.91 (1.84-1.99) and 3.81 (3.67-3.96) was observed for patients with NHL at age 75+ as compared to 25-44 in the US and UK, respectively. For patients with myeloma, excess mortality ratios of 2.79 (2.52-3.09) and 3.60 (3.27-3.962) for patients age 75+ compared to 25-44 were observed, respectively, for the US and UK. Adjustment for gender, ethnicity, period of diagnosis, and income (UK data only) did not significantly affect excess mortality ratios. Conclusions Survival of patients with lymphoma, especially patients with HL, is dramatically lower for older patients in both the US and UK. Older patients with lymphoma had a higher survival in the US as compared to the UK. This finding suggests that older patients in the UK may experience under-treatment. Physicians should be encouraged to evaluate patients' frailty and co-morbidities as well as their age when considering treatment options for patients with lymphoma and myeloma. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Trends in Self-Poisoning: Admissions to a Central London Hospital, 1991–1994

1997 ◽  
Vol 90 (9) ◽  
pp. 496-498 ◽  
Author(s):  
Christopher J B Mcevedy
Keyword(s):  
Clinical Practice ◽  
Psychiatric Disorder ◽  
Age Groups ◽  
Common Reason ◽  
Completed Suicide ◽  
Younger Age ◽  
Increased Risk ◽  
The Mean ◽  
The Uk ◽  
Reason For Admission

Self-poisoning is a common reason for admission to hospital; and, although most patients admitted do not have a psychiatric disorder, as a group they are at greatly increased risk of completed suicide. Admissions to a hospital in Central London over a four-year period were examined with special attention to patients admitted more than once. From 1991 to 1994 admissions for self-poisoning rose by 108%, with larger increases in the younger age groups of both sexes. 9% of patients were admitted more than once, the mean interval to repetition being three months. A third of the repeaters were readmitted within one month. The increase in admissions for self-poisoning, which has been noted elsewhere in the UK, is unlikely to be due wholly to changes in clinical practice. In view of the relation between parasuicide and suicide, further research and analysis is urgently needed.

The Descriptive Epidemiology and Outcomes of Hospitalized Burn Patients in Southern Turkey: Age-specific Mortality Patterns

2020 ◽  
Author(s):  
Kayhan Gurbuz ◽  
Mete Demir
Keyword(s):  
Mortality Rate ◽  
Descriptive Analysis ◽  
Age Groups ◽  
Total Body Surface Area ◽  
Multivariate Regression Analysis ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Age Group ◽  
Specific Mortality ◽  
Fire Flame

Abstract The current descriptive analysis was designed to document the common epidemiologic characteristics and outcomes of burn injuries, and age-specific mortality patterns covering all age groups admitted for treatment to the Burn Center of Adana City Training and Research Hospital (ACTRH). Medical records were retrospectively analyzed. The patients were stratified into two age groups as pediatric and adults, and then into ten sub-age groups. Among the 946 patients of the study population, there were 24 mortalities with a mortality rate of 2.5%. Patients within the age range of 70-79 years had the highest mortality rate of 33.3%; followed by 60-69, 80+, 18-29, 10-17, and &lt;5 sub-age groups, whose mortality rates were, 13.0%, 7.8%, 7.2%, 2.4%, 0.5%, respectively. In terms of multivariate regression analysis of factors predicting mortality among burn patients in all age groups, fire-flame related burns, age ≥18 years, total body surface area burned ≥20 percent (TBSA ≥20%), the existence of inhalation injury, deep partially/full-thickness burns were found to be significant prognostic factors of mortality. The strongest association was seen in TBSA ≥60% segment (p&lt;0.0001), which had 25.9 times more death risk. As expected, a similar trend was detected when the age groups stratified into age groups, and the strongest association was in the 60+ sub-age group (p&lt;0.0001), whose had 5.84 times more likely death; followed by 29-59, 18-29 sub-age groups, with the ORs of 2.12 (95%CI=1.25-3.61), 2.08 (95%CI=1.90-4.05), respectively. Oppose to these findings; the 0-17 sub-age group was not found to have a statistically significant effect in predicting mortality.

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