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The Elderly Patient

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Penetrating Trauma

Abstract

The geriatric population is the fastest growing age group today, and geriatric trauma accounts for a significant proportion of admissions to trauma centers. Due to functional changes with age, preexisting diseases, and pre-injury medications, geriatric trauma patients have limited physiological reserves and, therefore, require much more aggressive evaluation and treatment than their younger counterparts. A low threshold for field triage directly to a trauma center is warranted in elderly trauma patients. The primary and secondary survey follows ATLS guidelines; however, age-related conditions impact patient evaluation. The treatment algorithms for penetrating trauma in the elderly are no different. In any bleeding elderly patient, consider damage control interventions early. Selective nonoperative management of penetrating solid organ injuries, applied in many young trauma victims, is more likely to fail in older patients and, in general, should be reserved for low-grade injuries. When managed successfully, a significant number of elderly patients sustaining penetrating trauma will be able to return to levels of reasonable function and thus justify aggressive management.

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Recommended Reading

  1. American College of Surgeons, Committee on Trauma (1999) Resources for optimal care of the injured patient. American College of Surgeons, Chicago

    Google Scholar 

  2. Bulger EM, Arneson MA, Mock CN et al (2000) Rib fractures in the elderly. J Trauma 48:1040–1046; discussion 1046–1047

    Article  CAS  PubMed  Google Scholar 

  3. Callaway DW, Wolfe R (2007) Geriatric trauma. Emerg Med Clin North Am 25:837–860

    Article  PubMed  Google Scholar 

  4. Chang DC, Bass RR, Cornwell EE et al (2008) Undertriage of elderly trauma patients to state-designated trauma centers. Arch Surg 143:776–781; discussion 782

    Article  PubMed  Google Scholar 

  5. Demetriades D, Sava J, Alo K et al (2001) Old age as a criterion for trauma team activation. J Trauma 51:754–756; discussion 756–757

    Article  CAS  PubMed  Google Scholar 

  6. Demetriades D, Karaiskakis M, Velmahos G et al (2002) Effect on outcome of early intensive management of geriatric trauma patients. Br J Surg 89:1319–1322

    Article  CAS  PubMed  Google Scholar 

  7. Demetriades D, Hadjizacharia P, Constantinou C et al (2006) Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg 244:620–628

    PubMed  PubMed Central  Google Scholar 

  8. Grossman MD, Miller D, Scaff DW et al (2002) When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma. J Trauma 52:242–246

    Article  PubMed  Google Scholar 

  9. Harbrecht BG, Peitzman AB, Rivera L et al (2001) Contribution of age and gender to outcome of blunt splenic injury in adults: multicenter study of the eastern association for the surgery of trauma. J Trauma 51:887–895

    Article  CAS  PubMed  Google Scholar 

  10. Inaba K, Goecke M, Sharkey P et al (2003) Long-term outcomes after injury in the elderly. J Trauma 54:486–491

    Article  PubMed  Google Scholar 

  11. Jacobs DG, Plaisier BR, Barie PS et al (2003) Practice management guidelines for geriatric trauma: the EAST Practice Management Guidelines Work Group. J Trauma 54:391–416

    Article  PubMed  Google Scholar 

  12. Kuhne CA, Ruchholtz S, Kaiser GM et al (2005) Working Group on Multiple Trauma of the German Society of Trauma. Mortality in severely injured elderly trauma patients-when does age become a risk factor? World J Surg 29:1476–1482

    Article  PubMed  Google Scholar 

  13. Lustenberger T, Inaba K, Schnüriger B et al (2011) Gunshot injuries in the elderly: patterns and outcomes. A national trauma databank analysis. World J Surg 35:528–534

    Article  PubMed  Google Scholar 

  14. McGwin G Jr, Melton SM, May AK et al (2000) Long-term survival in the elderly after trauma. J Trauma 49:470–476

    Article  PubMed  Google Scholar 

  15. Nagy KK, Smith RF, Roberts RR et al (2000) Prognosis of penetrating trauma in elderly patients: a comparison with younger patients. J Trauma 49:190–193; discussion 193–194

    Article  CAS  PubMed  Google Scholar 

  16. Rehn M, Eken T, Kruger AJ et al (2009) Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines. Scand J Trauma Resusc Emerg Med 17:1

    Article  PubMed  PubMed Central  Google Scholar 

  17. Roth BJ, Velmahos GC, Oder DB et al (2001) Penetrating trauma in patients older than 55 years: a case-control study. Injury 32:551–554

    Article  CAS  PubMed  Google Scholar 

  18. Scalea TM, Simon HM, Duncan AO et al (1990) Geriatric blunt multiple trauma: improved survival with early invasive monitoring. J Trauma 30:129–134; discussion 134–136

    Article  CAS  PubMed  Google Scholar 

  19. United States Census Bureau (2008) Age groups and Sex 2008. United States Census Bureau, Washington, DC

    Google Scholar 

  20. Velmahos GC, Toutouzas KG, Radin R et al (2003) Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg 138:844–851

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University, Theodor-Stern-Kai 7, D-60590, Frankfurt /Main, Germany

    Thomas Lustenberger

  2. Division of Trauma and Surgical Critical Care, LAC + USC Medical Center, 1200 North State Street, IPT-C5L100, Los Angeles, CA, 90033 – 4525, USA

    Kenji Inaba

Authors
  1. Thomas Lustenberger
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  2. Kenji Inaba
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Correspondence to Thomas Lustenberger .

Editor information

Editors and Affiliations

  1. Professor of Surgery Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital Harvard University Medical School, Boston, USA

    George C. Velmahos

  2. Professor Emeritus, Department of Surgery, University of the Witwatersrand Medical School, Milpark Hospital Academic Trauma Centre and Leratong Hospital, Johannesburg, South Africa

    Elias Degiannis

  3. Honorary Senior Lecturer, Department of Surgery, University of the Witwatersrand Medical School, Johannesburg, South Africa

    Dietrich Doll

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Lustenberger, T., Inaba, K. (2017). The Elderly Patient. In: Velmahos, G., Degiannis, E., Doll, D. (eds) Penetrating Trauma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49859-0_72

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  • DOI: https://doi.org/10.1007/978-3-662-49859-0_72

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-49857-6

  • Online ISBN: 978-3-662-49859-0

  • eBook Packages: MedicineMedicine (R0)

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