Geriatric Trauma Resuscitation

1
Geriatric Trauma Resuscitation

• Kevin L. Ferguson MD FACEP
• Clinical Assistant Professor of Emergency
  Medicine
• University of Florida
• Gainesville, Florida

2
Geriatric Population

• 12.5 of population age gt 65 (1990)
• 28 of all deaths by trauma
• Estimated at 35 Million in 1995
• Estimated to be 52 M by 2020
• Anticipated increased participation in activities
  likely to incur injury

3
Demographics

• Analysis of EMS dispatch activity of 1154
  patients, 70 year old, over one year in Tucson,
  AZ
• 65.1 women 34.9 men
• 53.1 70-79 39.3 80-89 7.6 90
• Involved in 21.9 of all 911 calls
• EMS use rate 83.8/1000 vs... 42/1000 for younger
  patients

Spaite DW, Criss EA, Valenzuela TD, et al Ann
Emerg Med Dec... 1990191418-1421
4
Mechanisms of Injury

• Fall 60.7 78.9 on level surface,10 med.
  etiol
• MVA 21.5 71.8 gt 2 vehicles
• Fight 2.4
• Acc. poison 2.3
• Choking 2.1
• Self inflicted inj 1.7 includes ingestions
• Assault 0.7
• Misc.. 8.6 Drowning, MCA, burns etc..

Spaite DW, Criss EA, Valenzuela TD, et al Ann
Emerg Med Dec.. 1990191418-1421
5
Patterns of Injury

• Head/Face 25.1
• Upper Extremity 17.2
• Hip 14.5
• Lower Extremity 13.8
• Spine 9.8 More in MVAs
• Chest/Abd 5.0

Spaite DW, Criss EA, Valenzuela TD, et al Ann
Emerg Med Dec.. 1990191418-1421
6
Pre-existing Co-morbid factors

• Age 70.5 yr. range 60-91
• Sex 58 male 42 female
• Prior Medical Illness
• Pulmonary 15
• Cardiac 46
• Renal 1
• Diabetes Mellitus 11
• Other 57

Shapiro, Bartlett et alAm Surgeon 60(9)695-8
Sept 1994
7
Case Control Study of Major Trauma in Geriatric
Patients

• Data from Major Trauma Outcome Study (MTOS) by
  ACS
• Analysis of 46,613 major trauma patients admitted
  to 120 Trauma Centers over 4 years
• included age, mechanism of injury, outcome,
  length of stay, complications vitals signs,
  Glasgow coma score, Trauma Score, AIS, and
  H-ICD-9CM codes
• Data used to establish age-dependent mortality
  rates

8
MTOS Methods

• More detailed analysis of Washington Hospital
  Center (WHC) n4,098
• included DRGs costs, charges
• autopsy records analyzed for unknown pre-existing
  disease
• Trauma research records
• Resuscitation chart reviews
• Hospital chart review

9
MTOS Results

• ...at any ISS level, survival is lower for the
  older than for younger patients
• older non-survivors had a mean TS 3 points higher
  that younger nonsurvivors
• ...older patients with a TS gt 13 had a
  mortality 10 times higher than the corresponding
  group of younger patients...(those) who appear to
  have a good prognosis are much more likely to
  die.

10
MTOS Results

• Older patients with a good TS derived prognosis
  may in fact have poor outcomes.
• 2/3 elderly nonsurvivors arrived with a SBP gt 90
  compared to only 28 of young nonsurvivors
• Autopsy revealed 30 with substantial coronary
  artery disease ( occult?)
• Average hospital stay was twice as long for
  elderly vs.. younger group

11
MTOS Summary ConclusionsBeware the STABLE
elderly patient

• Overall mortality of older patients is 89
  greater than younger patients
• Mortality has a high incidence of associated head
  injury
• ISS, when adjusted for age, is a good predictor
  of mortality
• Apparently well older trauma patients with TS gt13
  or SBP gt90 has a significant chance of death

12
MOI Frequency and Mortality