scholarly journals Change in Age Distribution of the Injuries and Comparison of Different Scoring Tools in Predicting Mortality Among Geriatric Trauma Patients

2020 ◽  
Author(s):  
Libing Jiang ◽  
Zhongjun Zheng ◽  
Mao Zhang
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Survival Group ◽  
Elderly Trauma Patients ◽  
Scoring Tools ◽  
Death Group

Abstract Purpose: The aim of this study was to describe the age trend of trauma patients and to compare different scoring tools to predict in-hospital mortality in elderly trauma patients.Methods: National Trauma Database (NTDB) in the United States from 2005 to 2015 and the Trauma Register DGU® in German from 1994 to 2012 was searched to describe age change of trauma patients. Then we secondly analyzed the data published in http://datadryad.org/. According to the in-hospital survival status, patients were divided into survival group and non-survival group. Receiver Operating Characteristic Curve (ROC) analysis was used to evaluated the value of ISS (injury severity score); NISS (new injury severity score), APACHE Ⅱ (Acute Physiology and Chronic Health Evaluation Ⅱ), SPAS Ⅱ (simplified acute physiology score Ⅱ) and TRISS (Trauma and Injury Severity Score) in predicting in-hospital mortality among geriatric trauma patients.Results:The analysis of NTDB showed the percentage of geriatric trauma has increased from 0.18 to 0.30, 2005-2015. The analysis of DGU showed the mean age rose from 39.11 in 1993 to 51.10 in 2013, and the percentage of patients aged ≥60 rose from 16.5% to 37.5%. A total of 311 patients aged more than 65 years were secondly analyzed. One hundred and sixty-four (52.73%) patients died in the hospital. ISS, NISS, APACHE, and SAPS in the death group were significantly higher than those in the survival group, but TRISS in the death group was significantly lower than those in the survival group. The AUC of APACHE Ⅱ was 0.715, ISS was 0.807, NISS was 0.850, SPAS Ⅱ was 0.725, and TRISS was 0.828.Conclusion:The increasing number of trauma in the elderly is a challenge for current and future trauma management. Compared with APACHE and SAPS, ISS, NISS and TRISS are more suitable for predicting in-hospital mortality in elderly trauma patients.

scholarly journals The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients

2020 ◽  
Author(s):  
Libing Jiang ◽  
Zhongjun Zheng ◽  
Mao Zhang
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Secondary Analysis ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Survival Group ◽  
Scoring Tools ◽  
Death Group

Abstract Purpose: The study aimed to test the incidence of geriatric trauma is increasing and evaluate different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients.Methods: Part 1: Annual reports released by the National Trauma Database (NTDB) in the United States from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to test the incidence of geriatric trauma is increasing. Part 2: Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level Ⅰ trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE Ⅱ (Acute Physiology and Chronic Health Evaluation Ⅱ) and SPAS Ⅱ (simplified acute physiology score Ⅱ) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated.Results: Part 1: The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18% to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥60 years rose from 16.5% to 37.5%. Part 2: The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE Ⅱ, and SAPS Ⅱ in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE Ⅱ, and SAPS Ⅱ for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715 and 0.725, respectively.Conclusion: The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE Ⅱ and SAPS Ⅱ for the prediction of in-hospital mortality in geriatric trauma patients.

scholarly journals The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Libing Jiang ◽  
Zhongjun Zheng ◽  
Mao Zhang
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Apache Ii ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Survival Group ◽  
Saps Ii ◽  
Scoring Tools

Abstract Purpose The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients. Methods Annual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level I trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated. Results The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE II, and SAPS II in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715, and 0.725, respectively. Conclusion The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.

scholarly journals Change in age distribution of the injuries and comparison of different scoring tools in predicting mortality among geriatric trauma patients

2020 ◽  
Author(s):  
Libing Jiang ◽  
Zhongjun Zheng ◽  
Mao Zhang
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Secondary Analysis ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Survival Group ◽  
Change Tendency ◽  
Death Group

Abstract Purpose: The aim of this study was to describe the age change tendency of trauma patients and to test the accuracy of different scoring tools in prediction of in-hospital mortality in case of geriatric trauma.Methods: Annual reports released by the National Trauma Database (NTDB) in the United States from 2005 to 2015 and the Trauma Register DGU® in German from 1994 to 2012 were used to describe the age change tendency of trauma patients. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level Ⅰ trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into survival group and non-survival group. Receiver Operating Characteristic Curve (ROC) analysis was used to evaluated the predictive performance of the ISS (injury severity score); NISS (new injury severity score), APACHE Ⅱ (Acute Physiology and Chronic Health Evaluation Ⅱ), SPAS Ⅱ (simplified acute physiology score Ⅱ) and TRISS (Trauma and Injury Severity Score) in prediction of in-hospital mortality among geriatric trauma patients. Results: The analysis of the NTDB showed the proportion of geriatric trauma increased from 18% to 30% from 2005 to 2015. The analysis of the DGU® showed the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥60 rose from 16.5% to 37.5%. The secondary analysis indicated one hundred and sixty-four (52.73%) patients died in the hospital. The ISS, NISS, APACHE Ⅱ, and SAPS Ⅱ in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUC of the ISS, NISS, TRISS, APACHE Ⅱ, and SAPS Ⅱ was 0.807, 0.850, 0.828, 0.715 and 0.725, respectively.Conclusion: The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the accuracy of the APACHE Ⅱ and SAPS Ⅱ to predict in-hospital mortality in case of geriatric trauma.

scholarly journals Mortality Factors Regarding the Injury Severity Score in Elderly Trauma Patients

2012 ◽  
Vol 6 (3) ◽  
pp. 192-195 ◽  
Author(s):  
Wen-Kuang Chiang ◽  
Shu-Tien Huang ◽  
Wen-Han Chang ◽  
Ming-Yuan Huang ◽  
Ding-Kuo Chien ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
Mortality Factors ◽  
Elderly Trauma Patients

scholarly journals Early experience of a regional trauma center in Gangwon province: First step toward organizing a regional trauma system

2019 ◽  
Vol 27 (4) ◽  
pp. 202-210
Author(s):  
Kwangmin Kim ◽  
Hongjin Shim ◽  
Pil Young Jung ◽  
Seongyup Kim ◽  
Hui-Jae Bang ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma System ◽  
Mortality Rates ◽  
Trauma Patients ◽  
Before And After ◽  
The Impact

Background: The Korean Ministry of Health and Welfare decided to establish a trauma medical service system to reduce preventable deaths. OO hospital in Gangwon Province was selected as a regional trauma center and was inaugurated in 2015. Objectives: This study examines the impact of this center, comparing mortality and other variables before and after inaugurating the center. Methods: Severely injured patients (injury severity score > 15) presenting to OO hospital between January 2014 and December 2016 were enrolled and categorized into two groups: before trauma center (n = 365) and after trauma center (n = 904). Patient characteristics, variables, and patient outcomes (including mortality rate) before and after the establishment of trauma centers were compared accordingly for both groups. Risk factors for in-hospital mortality were also identified. Results: Probability of survival using trauma and injury severity score (%) method was significantly lower in the after trauma center group (81.3 ± 26.1) than in the before trauma center group (84.7 ± 21.0) (p = 0.014). In-hospital mortality rates were similar in both groups (before vs after trauma center group: 13.2% vs 14.2%; p = 0.638). The Z and W statistics revealed higher scores in the after trauma center group than in the before trauma center group (Z statistic, 4.69 vs 1.37; W statistic, 4.52 vs 2.10); 2.42 more patients (per 100 patients) survived after trauma center establishment. Conclusion: Although the mortality rates of trauma patients remained unchanged after the trauma center establishment, the Z and W statistics revealed improvements in the quality of care.

A Comprehensive Investigation of Comorbidities, Mechanisms, Injury Patterns, and Outcomes in Geriatric Blunt Trauma Patients

2016 ◽  
Vol 82 (11) ◽  
pp. 1055-1062 ◽  
Author(s):  
Carlos V. R. Brown ◽  
Kevin Rix ◽  
Amanda L. Klein ◽  
Brent Ford ◽  
Pedro G. R. Teixeira ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Geriatric Patients ◽  
Injury Severity ◽  
Older Age ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Injury Patterns ◽  
Abbreviated Injury Scale

The geriatric population is growing and trauma providers are often tasked with caring for injuries in the elderly. There is limited information regarding injury patterns in geriatric trauma patients stratified by mechanism of injury. This study intends to investigate the comorbidities, mechanisms, injury patterns, and outcomes in geriatric blunt trauma patients. A retrospective study of the 2012 National Trauma Databank was performed. Adult blunt trauma patients were identified; geriatric (>/=65) patients were compared with younger (<65) patients regarding admission demographics and vital signs, mechanism and severity of injury, and comorbidities. The primary outcome was injuries sustained and secondary outcomes included mortality, length of stay in the intensive care unit and hospital, and ventilator days. There were 589,830 blunt trauma patients who met the inclusion criteria, including 183,209 (31%) geriatric and 406,621 (69%) nongeriatric patients. Falls were more common in geriatric patients (79 vs 29%, P < 0.0001). Geriatric patients less often had an Injury Severity Score >/=16 (18 vs 20%, P < 0.0001) but more often a head Abbreviated Injury Scale >/=3 (24 vs 18%, P < 0.0001) and lower extremity Abbreviated Injury Scale >/=3 (24% vs 8%, P < 0.0001). After logistic regression older age was an independent risk factor for mortality for the overall population and across all mechanisms. Falls are the most common mechanism for geriatric trauma patients. Geriatric patients overall present with a lower Injury Severity Score, but more often sustain severe injuries to the head and lower extremities. Injury patterns vary significantly between older and younger patients when stratified by mechanism. Mortality is significantly higher for geriatric trauma patients and older age is independently associated with mortality across all mechanisms.

Activation of Massive Transfusion for Elderly Trauma Patients

2015 ◽  
Vol 81 (10) ◽  
pp. 945-949 ◽  
Author(s):  
Jason S. Murry ◽  
Andrea A. Zaw ◽  
David M. Hoang ◽  
Devorah Mehrzadi ◽  
Danielle Tran ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Glasgow Coma Scale ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Coma Scale ◽  
Elderly Trauma Patients

Massive transfusion protocol (MTP) is used to resuscitate patients in hemorrhagic shock. Our goal was to review MTP use in the elderly. All trauma patients who required activation of MTP at an urban Level I trauma center from January 1, 2011 to December 31, 2013 were reviewed retrospectively. Elderly was defined as age ≥ 60 years. Sixty-six patients had MTP activated: 52 non-elderly (NE) and 14 elderly (E). There were no statistically significant differences between the two cohorts for gender, injury severity score, head abbreviated injury scale, emergency department Glasgow Coma Scale, initial hematocrit, intensive care unit length of stay, or hospital length of stay. Mean age for NE was 35 years and 73 years for E ( P < 0.01). Less than half (43%) of E patients with activation of MTP received 10 or more units of blood products compared with 69 per cent of the NE ( P = 0.07). Mortality rates were similar in the NE and the E (53% vs 50%, P = 0.80). After multivariate analysis with Glasgow Coma Scale, injury severity score, and blunt versus penetrating trauma, elderly age was not a predictor of mortality after MTP ( P = 0.35). When MTP is activated, survival to discharge in elderly trauma patients is comparable to younger patients.

Comparative Analysis of the Paravertebral Analgesic Pump Catheter with the Epidural Catheter in Elderly Trauma Patients with Multiple Rib Fractures

2017 ◽  
Vol 83 (4) ◽  
pp. 399-402 ◽  
Author(s):  
Brian S. Shapiro ◽  
Tarik Wasfie ◽  
Mathew Chadwick ◽  
Kimberly R. Barber ◽  
Raquel Yapchai
Keyword(s):  
Epidural Analgesia ◽  
Injury Severity Score ◽  
Severity Score ◽  
Pain Control ◽  
Injury Severity ◽  
Rib Fractures ◽  
Trauma Patients ◽  
Multiple Rib Fractures ◽  
Epidural Catheters ◽  
Elderly Trauma Patients

Presently, trauma guidelines recommend epidural analgesia as the optimal modality of pain relief from rib fractures. They are not ideally suited for elderly trauma patients and have disadvantages including bleeding risk. The paravertebral analgesic pump (PVP) eliminates such disadvantages and includes ease of placement in the trauma setting. This study compares pain control in patients treated by EPI versus PVP. This is a retrospective, historical cohort study comparing two methods of pain management in the trauma setting. Before 2010, patients who had epidural catheters (EPI) placed for pain control were compared with patients after 2010 in which the PVP was used. All patients had multiple rib fractures as diagnosed by CT scan. Analysis was adjusted for age, number of fractures, and comorbid conditions. Multiple linear regression analysis was conducted to compare average reported pain. A total of 110 patients, 31 PVP and 79 epidural catheters, were included in the study. Overall mean age was 65 years. The mean Injury Severity Score was 12.0 (EPI) and 11.1 (PVP). Mean number rib fractures was 4.29 (EPI) and 4.71 (PVP). PVP was associated with a 30 per cent greater decrease in pain than that seen with EPI (6.0–1.9 vs 6.4–3.4). After controlling for age, Injury Severity Score, and number of rib fractures, there were no differences in intensive care unit or total length of stay (P = 0.35) or in pain score (3.76 vs 3.56, P = 0.64). In conclusion, the PVP compares well with epidural analgesia in older trauma patients yet is safe, well tolerated, and easily inserted.

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