Trauma in Geriatric Age

  • Emanuele Rausa
  • Federico Coccolini
  • Giulia Montori
  • Maria Agnese Kelly
  • Baggi Paolo
  • Dario Piazzalunga
  • Cecilia Merli
  • Luca Ansaloni
Chapter

Abstract

The definition of the word “elderly” is not one that has been universally agreed though it is generally accepted that it pertains to a subset of population between 45 and 75 years old [1]. People are living much longer worldwide. Currently, the population over 60 years of age accounts for over 40 million persons in the United States. Over the next 20 years, the population over 65 years of age is projected to double in size, reaching 82.3 million (approximately 22% of the total population) by 2040 [2].

References

  1. 1.
    Adams SD, Cotton BA, McGuire MF, Dipasupil E, Podbielski JM, Zaharia A, et al. Unique pattern of complications in elderly trauma patients at a Level I trauma center. J Trauma Acute Care Surg. 2012;72(1):112–8.CrossRefGoogle Scholar
  2. 2.
    Projections of future growth of the older. population. 2016. Available at: http://www.aoa.gov/aoaroot/aging_statistics/future_growth/future_growth.aspx#age. Accessed 24 Feb 2017.
  3. 3.
    Wier LM, Levit K, Stranges E, et al. HCUP facts and figures: statistics on hospital-based care in the United States, 2012. Rockville: Agency for Healthcare Research and Quality; 2014. Available at: http://www.hcup-us.ahrq.gov/reports.jsp.Google Scholar
  4. 4.
    NHTSA Traffic Safety Facts. 2014. Older population. Available at: https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812273.Google Scholar
  5. 5.
    Carpenter CR, Shelton E, Fowler S, Suffoletto B, Platts-Mills TF, Rothman RE, et al. Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta-analysis. Acad Emerg Med. 2015;22(1):1–21.CrossRefGoogle Scholar
  6. 6.
    Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54(3):478–85.CrossRefGoogle Scholar
  7. 7.
    Ogilvie R, Curtis K, Lam M, McCloughen A, Foster K. The burden of youth: major traumatic injury in adolescents and young adults managed in the Australian Capital Territory. J Trauma Nurs. 2014;21(5):218–27.CrossRefGoogle Scholar
  8. 8.
    Vieira ER, Palmer RC, Chaves PH. Prevention of falls in older people living in the community. BMJ. 2016;353:i1419.CrossRefGoogle Scholar
  9. 9.
    Brown CV, Rix K, Klein AL, Ford B, Teixeira PG, Aydelotte J, et al. A comprehensive investigation of comorbidities, mechanisms, injury patterns, and outcomes in geriatric blunt trauma patients. Am Surg. 2016;82(11):1055–62.PubMedGoogle Scholar
  10. 10.
    Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. WISQARS fatal injuries: mortality reports. Available at: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html.
  11. 11.
    Demetriades D, Sava J, Alo K, Newton E, Velmahos GC, Murray JA, et al. Old age as a criterion for trauma team activation. J Trauma. 2001;51(4):754–6. discussion 6-7.CrossRefGoogle Scholar
  12. 12.
    Martin JT, Alkhoury F, O’Connor JA, Kyriakides TC, Bonadies JA. ‘Normal’ vital signs belie occult hypoperfusion in geriatric trauma patients. Am Surg. 2010;76(1):65–9.PubMedGoogle Scholar
  13. 13.
    Tornetta P, Mostafavi H, Riina J, Turen C, Reimer B, Levine R, et al. Morbidity and mortality in elderly trauma patients. J Trauma. 1999;46(4):702–6.CrossRefGoogle Scholar
  14. 14.
    Hashmi A, Ibrahim-Zada I, Rhee P, Aziz H, Fain MJ, Friese RS, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014;76(3):894–901.CrossRefGoogle Scholar
  15. 15.
    Maxwell CA, Mion LC, Mukherjee K, Dietrich MS, Minnick A, May A, et al. Preinjury physical frailty and cognitive impairment among geriatric trauma patients determine postinjury functional recovery and survival. J Trauma Acute Care Surg. 2016;80(2):195–203.CrossRefGoogle Scholar
  16. 16.
    Labib N, Nouh T, Winocour S, Deckelbaum D, Banici L, Fata P, et al. Severely injured geriatric population: morbidity, mortality, and risk factors. J Trauma. 2011;71(6):1908–14.PubMedGoogle Scholar
  17. 17.
    Pracht EE, Langland-Orban B, Flint L. Survival advantage for elderly trauma patients treated in a designated trauma center. J Trauma. 2011;71(1):69–77.CrossRefGoogle Scholar
  18. 18.
    Fleischman RJ, Adams AL, Hedges JR, Ma OJ, Mullins RJ, Newgard CD. The optimum follow-up period for assessing mortality outcomes in injured older adults. J Am Geriatr Soc. 2010;58(10):1843–9.CrossRefGoogle Scholar
  19. 19.
    Davidson GH, Hamlat CA, Rivara FP, Koepsell TD, Jurkovich GJ, Arbabi S. Long-term survival of adult trauma patients. JAMA. 2011;305(10):1001–7.CrossRefGoogle Scholar
  20. 20.
    Sammy I, Lecky F, Sutton A, Leaviss J, O’Cathain A. Factors affecting mortality in older trauma patients-A systematic review and meta-analysis. Injury. 2016;47(6):1170–83.CrossRefGoogle Scholar
  21. 21.
    Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation. 2008;117(11):1436–48.CrossRefGoogle Scholar
  22. 22.
    Heffernan DS, Thakkar RK, Monaghan SF, Ravindran R, Adams CA Jr, Kozloff MS, et al. Normal presenting vital signs are unreliable in geriatric blunt trauma victims. J Trauma. 2010;69(4):813–20.CrossRefGoogle Scholar
  23. 23.
    Greenwald SE. Ageing of the conduit arteries. J Pathol. 2007;211(2):157–72.CrossRefGoogle Scholar
  24. 24.
    Bonomo L, Larici AR, Maggi F, Schiavon F, Berletti R. Aging and the respiratory system. Radiol Clin N Am. 2008;46(4):685–702, v–vi.CrossRefGoogle Scholar
  25. 25.
    Candela-Toha AM, Recio-Vazquez M, Delgado-Montero A, del Rey JM, Muriel A, Liano F, et al. The calculation of baseline serum creatinine overestimates the diagnosis of acute kidney injury in patients undergoing cardiac surgery. Nefrologia. 2012;32(1):53–8.PubMedGoogle Scholar
  26. 26.
    Lach HW, Lorenz RA, L’Ecuyer KM. Aging muscles and joints: mobilization. Crit Care Nurs Clin North Am. 2014;26(1):105–13.CrossRefGoogle Scholar
  27. 27.
    Vaughan MS, Vaughan RW, Cork RC. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth Analg. 1981;60(10):746–51.CrossRefGoogle Scholar
  28. 28.
    Powers R. Neurobiology of aging. In: Cummings J, Coffey CE, editors. Textbook of geriatric neuropsychiatry. Washington: American Psychiatric Press; 2000. p. 33–79.Google Scholar
  29. 29.
    McIntyre A, Mehta S, Aubut J, Dijkers M, Teasell RW. Mortality among older adults after a traumatic brain injury: a meta-analysis. Brain Inj. 2013;27(1):31–40.CrossRefGoogle Scholar
  30. 30.
    Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Guidelines for the management of severe traumatic brain injury. I. Blood pressure and oxygenation. J Neurotrauma. 2007;24(Suppl 1):S7–13.PubMedGoogle Scholar
  31. 31.
    Schneider EB, Efron DT, MacKenzie EJ, Rivara FP, Nathens AB, Jurkovich GJ. Premorbid statin use is associated with improved survival and functional outcomes in older head-injured individuals. J Trauma. 2011;71(4):815–9.CrossRefGoogle Scholar
  32. 32.
    Wible EF, Laskowitz DT. Statins in traumatic brain injury. Neurotherapeutics. 2010;7(1):62–73.CrossRefGoogle Scholar
  33. 33.
    Miranda LB, Braxton E, Hobbs J, Quigley MR. Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg. 2011;114(1):72–6.CrossRefGoogle Scholar
  34. 34.
    Shoda N, Yasunaga H, Horiguchi H, Matsuda S, Ohe K, Kadono Y, et al. Risk factors affecting inhospital mortality after hip fracture: retrospective analysis using the Japanese diagnosis procedure combination database. BMJ Open. 2012;2(3):e000416.CrossRefGoogle Scholar
  35. 35.
    Gibson CL, Gray LJ, Bath PM, Murphy SP. Progesterone for the treatment of experimental brain injury; a systematic review. Brain. 2008;131(Pt 2):318–28.CrossRefGoogle Scholar
  36. 36.
    Kendrick D, Kumar A, Carpenter H, Zijlstra GA, Skelton DA, Cook JR, et al. Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev. 2014;28(11):Cd009848.Google Scholar
  37. 37.
    Puttnam R, Davis BR, Pressel SL, Whelton PK, Cushman WC, Louis GT, et al. Association of 3 different antihypertensive medications with hip and pelvic fracture risk in older adults: secondary analysis of a randomized clinical trial. JAMA Intern Med. 2017;177(1):67–76.CrossRefGoogle Scholar
  38. 38.
    De Bonis P, Trevisi G, de Waure C, Sferrazza A, Volpe M, Pompucci A, et al. Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS One. 2013;8(7):e68732.CrossRefGoogle Scholar
  39. 39.
    Howard JL, Cipolle MD, Horvat SA, Sabella VM, Reed JF, Fulda G, et al. Preinjury warfarin worsens outcome in elderly patients who fall from standing. J Trauma. 2009;66(6):1518–22. discussion 23-4.CrossRefGoogle Scholar
  40. 40.
    Kundu A, Sardar P, Chatterjee S, Aronow WS, Owan T, Ryan JJ. Minimizing the risk of bleeding with NOACs in the elderly. Drugs Aging. 2016;33(7):491–500.CrossRefGoogle Scholar
  41. 41.
    Eikelboom JW, Wallentin L, Connolly SJ, Ezekowitz M, Healey JS, Oldgren J, et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation. 2011;123(21):2363–72.CrossRefGoogle Scholar
  42. 42.
    Lorich D, Gardener M, Helfet D. Trauma to the pelvis and extremities. In: Norton J, Barie P, Bollinger R, Chang A, Lowry S, Mulvihill S, et al., editors. Surgery basic science and clinical evidence. New York: Springer; 2008. p. 505–20.Google Scholar
  43. 43.
    Stahel PF, Hammerberg EM. History of pelvic fracture management: a review. World J Emerg Surg. 2016;11:18.CrossRefGoogle Scholar
  44. 44.
    Morris RO, Sonibare A, Green DJ, Masud T. Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad Med J. 2000;76(900):646–50.CrossRefGoogle Scholar
  45. 45.
    Krappinger D, Kammerlander C, Hak DJ, Blauth M. Low-energy osteoporotic pelvic fractures. Arch Orthop Trauma Surg. 2010;130(9):1167–75.CrossRefGoogle Scholar
  46. 46.
    Balogh Z, King KL, Mackay P, McDougall D, Mackenzie S, Evans JA, et al. The epidemiology of pelvic ring fractures: a population-based study. J Trauma. 2007;63(5):1066–73. discussion 72-3.CrossRefGoogle Scholar
  47. 47.
    Dechert TA, Duane TM, Frykberg BP, Aboutanos MB, Malhotra AK, Ivatury RR. Elderly patients with pelvic fracture: interventions and outcomes. Am Surg. 2009;75(4):291–5.PubMedGoogle Scholar
  48. 48.
    Bazylewicz D, Konda S. A Review of the definitive treatment of pelvic fractures. Bull Hosp Jt Dis. 2016;74(1):6–11.Google Scholar
  49. 49.
    McCormack R, Strauss EJ, Alwattar BJ, Tejwani NC. Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis. 2010;68(4):281–91.PubMedGoogle Scholar
  50. 50.
    Rommens PM, Ossendorf C, Pairon P, Dietz SO, Wagner D, Hofmann A. Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature. J Orthop Sci. 2015;20(1):1–11.CrossRefGoogle Scholar
  51. 51.
    Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12:5.CrossRefGoogle Scholar
  52. 52.
    Schicho A, Schmidt SA, Seeber K, Olivier A, Richter PH, Gebhard F. Pelvic X-ray misses out on detecting sacral fractures in the elderly – Importance of CT imaging in blunt pelvic trauma. Injury. 2016;47(3):707–10.CrossRefGoogle Scholar
  53. 53.
    Kaufmann JE, Vischer UM. Cellular mechanisms of the hemostatic effects of desmopressin (DDAVP). J Thromb Haemost. 2003;1(4):682–9.CrossRefGoogle Scholar
  54. 54.
    White CE, Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures. Injury. 2009;40(10):1023–30.CrossRefGoogle Scholar
  55. 55.
    Wagner D, Ossendorf C, Gruszka D, Hofmann A, Rommens PM. Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg. 2015;41(4):349–62.CrossRefGoogle Scholar
  56. 56.
    Ojodu I, Pohlemann T, Hopp S, Rollmann MF, Holstein JH, Herath SC. Predictors of mortality for complex fractures of the pelvic ring in the elderly: a twelve-year review from a German level I trauma center. Injury. 2015;46(10):1996–8.CrossRefGoogle Scholar
  57. 57.
    Nagy KK, Smith RF, Roberts RR, Joseph KT, An GC, Bokhari F, et al. Prognosis of penetrating trauma in elderly patients: a comparison with younger patients. J Trauma. 2000;49(2):190–3. discussion 3-4.CrossRefGoogle Scholar
  58. 58.
    Lustenberger T, Inaba K, Schnuriger B, Barmparas G, Eberle BM, Lam L, et al. Gunshot injuries in the elderly: patterns and outcomes. A national trauma databank analysis. World J Surg. 2011;35(3):528–34.CrossRefGoogle Scholar
  59. 59.
    Talving P, Benfield R, Hadjizacharia P, Inaba K, Chan LS, Demetriades D. Coagulopathy in severe traumatic brain injury: a prospective study. J Trauma. 2009;66(1):55–61. discussion -2.CrossRefGoogle Scholar
  60. 60.
    Sugerman DE, Xu L, Pearson WS, Faul M. Patients with severe traumatic brain injury transferred to a Level I or II trauma center: United States, 2007 to 2009. J Trauma Acute Care Surg. 2012;73(6):1491–9.CrossRefGoogle Scholar
  61. 61.
    Biffl WL, Leppaniemi A. Management guidelines for penetrating abdominal trauma. World J Surg. 2015;39(6):1373–80.CrossRefGoogle Scholar
  62. 62.
    Brown CV, Shoemaker WC, Wo CC, Chan L, Demetriades D. Is noninvasive hemodynamic monitoring appropriate for the elderly critically injured patient? J Trauma. 2005;58(1):102–7.CrossRefGoogle Scholar
  63. 63.
    Montorfano MA, Pla F, Vera L, Cardillo O, Nigra SG, Montorfano LM. Point-of-care ultrasound and Doppler ultrasound evaluation of vascular injuries in penetrating and blunt trauma. Crit Ultrasound J. 2017;9(1):5.CrossRefGoogle Scholar
  64. 64.
    Colip CG, Gorantla V, LeBedis CA, Soto JA, Anderson SW. Extremity CTA for penetrating trauma: 10-year experience using a 64-detector row CT scanner. Emerg Radiol. 2016;24(3):223–32.CrossRefGoogle Scholar
  65. 65.
    Kuhajda I, Zarogoulidis K, Kougioumtzi I, Huang H, Li Q, Dryllis G, et al. Penetrating trauma. J Thorac Dis. 2014;6(Suppl 4):S461–5.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Hajibandeh S, Gumber AO, Wong CS. Laparoscopy versus laparotomy for the management of penetrating abdominal trauma: a systematic review and meta-analysis. Int J Surg. 2016;34:127–36.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Emanuele Rausa
    • 1
  • Federico Coccolini
    • 1
  • Giulia Montori
    • 1
  • Maria Agnese Kelly
    • 2
  • Baggi Paolo
    • 1
  • Dario Piazzalunga
    • 1
  • Cecilia Merli
    • 3
  • Luca Ansaloni
    • 1
  1. 1.Unit of General and Emergency SurgeryPapa Giovanni XXIII HospitalBergamoItaly
  2. 2.Department of Colorectal DiseasesSt. Vincent’s University Hospital, Elm ParkDublinIreland
  3. 3.Unit of Emergency MedicinePapa Giovanni XXIII HospitalBergamoItaly

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