TITLE

Young versus Old: Factors Affecting Mortality After Blunt Traumatic Injury

AUTHOR(S)
Schulman, Andrew M.; Claridge, Jeffrey A.; Young, Jeffrey S.
PUB. DATE
November 2002
SOURCE
American Surgeon;Nov2002, Vol. 68 Issue 11, p942
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Advanced age predicts poor outcome after trauma. We have previously demonstrated that prolonged occult hypoperfusion (POH), defined as serum lactic acid >2.4 mmol/L persisting for >12 hours, is also associated with worse outcomes. We hypothesized that older patients--a group with potentially less physiologic reserve--would be at greater risk from POH. Prospective data from adult blunt trauma patients admitted to a surgical/trauma intensive care unit from January 1, 1998 through December 31, 1999 were analyzed. Mortality, POH, Injury Severity Score (ISS), chronic health designation (CH) from the Acute Physiology and Chronic Health Evaluation, emergency department Glasgow Coma Scale score (EDGCS), emergency department systolic blood pressure (EDSBP), and gender were compared between older (>55 years) and younger (<56 years) patients and then between nonsurvivors and survivors within age cohorts. Two hundred sixty-four patients were analyzed: 195 younger and 69 older. Mortality was 8.3 per cent (22/264). Older patients had higher mortality (20.3% vs 4.1%, P < 0.05), higher CH (42.9% ± 1.3 vs 8.4% ± 0.6), lower ISS (22.6 ± 1.5 vs 25.6 ± 0.8, P < 0.05), higher EDGCS (12.9 ± 0.5 vs 10.7 ± 0.4, P < 0.05), and higher EDSBP (141.5 ± 4.1 vs 129.3 ± 2.2). There were no differences in incidence of POH and gender. Within both age cohorts nonsurvivors had higher ISS, lower EDGCS, and higher CH. Older patients with POH had 34.6 per cent mortality as compared with 11.6 per cent for no POH (P < 0.05). Mortality in younger patients was no different in the presence of POH, and all nonsurvivors were male. Despite lower ISS and higher EDGCS and EDSBP older patients had five times the mortality of younger patients. Age-specific mortality was influenced by POH and gender. POH was associated with higher mortality only in older patients. With less physiologic reserve older patients may not have been able to adequately compensate...
ACCESSION #
9474524

 

Related Articles

  • Cardiac Injuries Due To Blunt Trauma. Yetkin, Ufuk; Yürekli, İsmail; Bayrak, Serdar; Özbek, Cengiz; Özsöyler, İbrahim; Gü:rbüz, Ali // Internet Journal of Thoracic & Cardiovascular Surgery;2009, Vol. 13 Issue 1, p11 

    Blunt cardiac trauma develops frequently following motor-vehicle accidents and its mortality rate is high. Early use of echocardiography for the initial assessment of severely injured patients has facilitated to detect the associated cardiac injuries. Fast transportation, urgent diagnostic...

  • Splenic Trauma in Scotland: Demographics and Outcomes. Brady, Richard R. W.; Bandari, Mark; Kerssens, Jan J.; Paterson-Brown, Simon; Parks, Rowan W. // World Journal of Surgery;Nov2007, Vol. 31 Issue 11, p2111 

    Splenic trauma is a common organ injury following blunt abdominal trauma. In order to establish the contemporary epidemiology of blunt splenic trauma in Scotland and to detect risk factors associated with patient outcomes, analysis of a multi-center database of trauma patients was performed. The...

  • The Outcomes of Chest Trauma; A 10 Years Survey. Noorian, Sayed Ebrahim; Mahmoodieh, Mohsen; Dehghani, Amir // Journal of Isfahan Medical School;2/7/2011, Vol. 28 Issue 117, p1 

    Background: Trauma is the most common cause of death for people younger than 45 years. Chest injury is severely life-threatening and is associated with mortality and significant disability. Methods: This cross-sectional study was done on 252 treated patients with penetrating chest injuries...

  • Mortality Impact of Hypothermia After Cavitary Explorations in Trauma. Inaba, Kenji; Teixeira, Pedro G. R.; Rhee, Peter; Brown, Carlos; Salim, Ali; DuBose, Joseph; Chan, Linda S.; Demetriades, Demetrios // World Journal of Surgery;Apr2009, Vol. 33 Issue 4, p864 

    Background Admission hypothermia (core temperature ≤ 35°C) is an independent risk factor for mortality after trauma. The predictive value of perioperative core temperatures during acute trauma surgery, however, although widely employed as a criterion for initiating damage control, is...

  • Blunt Liver Injury in Children and Adults: Is There Really a Difference? KLAPHEKE, W. PATRICK; FRANKLIN, GLENN A.; Foley, David S.; Casos, Steven R.; Harbrecht, Brian G.; Richardson, J. David // American Surgeon;Sep2008, Vol. 74 Issue 9, p798 

    Hepatic injuries are increasingly managed nonoperatively with the availability of adjunctive procedures such as angiography, ERCP, and percutaneous drainage. Although extensively discussed in the adult population, little has been reported on outcomes and management of pediatric liver injury....

  • Oesophageal Foreign Bodies: An Experience with Rigid Oesophagoscopy in a Developing Country. Adedeji, T. O.; Haastrup, A. A. // East & Central African Journal of Surgery;Jul/Aug2014, Vol. 19 Issue 2, p25 

    Background: This study assessed the procedure of rigid oesophagoscopy for the management of impacted oesophageal FBs. Methods: A retrospective study of patients between January 2007 and December 2013 Results: There were total of 42 patients consisting of 30 (71.4%) males with male: female ratio...

  • Special Issue on rib fixation. Leenen, Luke // European Journal of Trauma & Emergency Surgery;Oct2010, Vol. 36 Issue 5, p405 

    The author reflects on the fixation and stabilization of the ribs. According to the author 25 percent of deaths are caused by thoracic trauma wherein limited attention is given aside from simple treatments. He states that complication like ventilator-associated pneumonia is incurred through...

  • Povrede retrohepatičkog dela donje Å¡uplje vene i jetre. Koprivica, Radenko; Cvijović, Radiša; Koprivica, Ranka; Smiljanić, Radmila // Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journ;Jun2008, Vol. 65 Issue 6, p481 

    Beckground. Injuries of the retrohepatic inferior vena cava, and the liver have mortality rate up to 71-78%. We presented a patient with combined injury of the retrohepatic inferior vena cava, liver, craniocerebral and thoracic traumas, inflicted in a traffic accident. Case report. Man, 20 years...

  • Pediatric blunt splenic trauma: a comprehensive review. Lynn, Karen N.; Werder, Gabriel M.; Callaghan, Rachel M.; Sullivan, Ashley N.; Jafri, Zafar H.; Bloom, David A. // Pediatric Radiology;Sep2009, Vol. 39 Issue 9, p904 

    Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury,...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics