Top

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Published in:

Open Access 01-12-2013 | Commentary

Improving adjustments for older age in pre-hospital assessment and care

Author: Marius Rehn

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2013

Abstract

Population estimates projects a significant increase in the geriatric population making elderly trauma patients more common. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired age-dependent physiologic reserve, use potent drugs and suffer from trauma system related shortcomings that influence outcomes. To improve adjustments for older age in pre-hospital assessment and care, several initiatives should be implemented. Decision-makers should make system revisions and introduce advanced point-of-care initiatives to improve outcome after trauma for the elderly.

Available only for authorised users

Statistics Norway: An ageing society. 2012,http://www.ssb.no/norge_en/bef_en.pdf,

Office for National Statistics: Population ageing in the United Kingdom, its constituent countries and the European Union. 2012,http://www.ons.gov.uk/ons/dcp171776_258607.pdf,

Mock C, Lormand J, Goosen J, Joshipura M, Peden M: Guidelines for essential trauma care. 2004, Geneva: World Health Organization

Demetriades D, Sava J, Alo K, Newton E, Velmahos GC, Murray JA, Belzberg H, Asensio JA, Berne TV: Old age as a criterion for trauma team activation. J Trauma. 2001, 51: 754-756. 10.1097/00005373-200110000-00022. discussion 756–757CrossRefPubMed

Coronado VG, Thomas KE, Sattin RW, Johnson RL: The CDC traumatic brain injury surveillance system: characteristics of persons aged 65 years and older hospitalized with a TBI. J Head Trauma Rehabil. 2005, 20: 215-228. 10.1097/00001199-200505000-00005.CrossRefPubMed

Grossman MD, Miller D, Scaff DW, Arcona S: When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma. J Trauma. 2002, 52: 242-246. 10.1097/00005373-200202000-00007.CrossRefPubMed

Oreskovich MR, Howard JD, Copass MK, Carrico CJ: Geriatric trauma: injury patterns and outcome. J Trauma. 1984, 24: 565-572. 10.1097/00005373-198407000-00003.CrossRefPubMed

Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002, 287: 356-359. 10.1001/jama.287.3.356.CrossRefPubMed

Battistella FD, Din AM, Perez L: Trauma patients 75 years and older: long-term follow-up results justify aggressive management. J Trauma. 1998, 44: 618-623. 10.1097/00005373-199804000-00010. discussion 623CrossRefPubMed

10.

ASA Physical Status Classification System. American Society of Anesthesiologists: 2012,http://www.asahq.org/clinical/physicalstatus.htm,

11.

Skaga NO, Eken T, Sovik S, Jones JM, Steen PA: Pre-injury ASA physical status classification is an independent predictor of mortality after trauma. J Trauma. 2007, 63: 972-978. 10.1097/TA.0b013e31804a571c.CrossRefPubMed

12.

Hollis S, Lecky F, Yates DW, Woodford M: The effect of pre-existing medical conditions and age on mortality after injury. J Trauma. 2006, 61: 1255-1260. 10.1097/01.ta.0000243889.07090.da.CrossRefPubMed

13.

Brewer ES, Reznikov B, Liberman RF, Baker RA, Rosenblatt MS, David CA, Flacke S: Incidence and predictors of intracranial hemorrhage after minor head trauma in patients taking anticoagulant and antiplatelet medication. J Trauma. 2011, 70: E1-E5. 10.1097/TA.0b013e3181e5e286.CrossRefPubMed

14.

Wong DK, Lurie F, Wong LL: The effects of clopidogrel on elderly traumatic brain injured patients. J Trauma. 2008, 65: 1303-1308. 10.1097/TA.0b013e318185e234.CrossRefPubMed

15.

Chang DC, Bass RR, Cornwell EE, Mackenzie EJ: Undertriage of elderly trauma patients to state-designated trauma centers. Arch Surg. 2008, 143: 776-781. 10.1001/archsurg.143.8.776. discussion 782CrossRefPubMed

16.

Kuhne CA, Ruchholtz S, Kaiser GM, Nast-Kolb D: Mortality in severely injured elderly trauma patients–when does age become a risk factor?. World J Surg. 2005, 29: 1476-1482. 10.1007/s00268-005-7796-y.CrossRefPubMed

17.

Soreide K, Kruger AJ, Vardal AL, Ellingsen CL, Soreide E, Lossius HM: Epidemiology and contemporary patterns of trauma deaths: changing place, similar pace, older face. World J Surg. 2007, 31: 2092-2103. 10.1007/s00268-007-9226-9.CrossRefPubMed

18.

Schiller WR, Knox R, Chleborad W: A five-year experience with severe injuries in elderly patients. Accid Anal Prev. 1995, 27: 167-174. 10.1016/0001-4575(94)00053-O.CrossRefPubMed

19.

Giannoudis PV, Harwood PJ, Court-Brown C, Pape HC: Severe and multiple trauma in older patients; incidence and mortality. Injury. 2009, 40: 362-367. 10.1016/j.injury.2008.10.016.CrossRefPubMed

20.

Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S: Publication guidelines for quality improvement in health care: evolution of the SQUIRE project. Qual Saf Health Care. 2008, 17 (Suppl 1): i3-i9. 10.1136/qshc.2008.029066.PubMedCentralCrossRefPubMed

21.

ACS-COT: Trauma performance improvement reference manual. 2002, Chicago: American College of Surgeons

22.

Newgard CD, Zive D, Holmes JF, Bulger EM, Staudenmayer K, Liao M, Rea T, Hsia RY, Wang NE, Fleischman R: A multisite assessment of the American College of Surgeons Committee on Trauma field triage decision scheme for identifying seriously injured children and adults. J Am Coll Surg. 2011, 213: 709-721. 10.1016/j.jamcollsurg.2011.09.012.PubMedCentralCrossRefPubMed

23.

Chisholm KM, Harruff RC: Elderly deaths due to ground-level falls. Am J Forensic Med Pathol. 2010, 31: 350-354. 10.1097/PAF.0b013e3181f69c87.CrossRefPubMed

24.

Sasser SM, Hunt RC, Sullivent EE, Wald MM, Mitchko J, Jurkovich GJ, Henry MC, Salomone JP, Wang SC, Galli RL: Guidelines for field triage of injured patients. Recommendations of the national expert panel on field triage. MMWR Recomm Rep. 2009, 58: 1-35.PubMed

25.

Lerner EB: Studies evaluating current field triage: 1966–2005. Prehosp Emerg Care. 2006, 10: 303-306. 10.1080/10903120600723921.CrossRefPubMed

26.

Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, Wald MM, Jurkovich GJ, Newgard CD, Lerner EB: Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012, 61: 1-20.PubMed

27.

Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Bottiger B: European resuscitation council guidelines for resuscitation 2010. Resuscitation. 2010, 81: 1219-1276. 10.1016/j.resuscitation.2010.08.021.CrossRefPubMed

28.

Rehn M, Lossius HM, Tjosevik KE, Vetrhus M, Ostebo O, Eken T: Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre. Br J Surg. 2012, 99: 199-208. 10.1002/bjs.7794.PubMedCentralCrossRefPubMed

29.

Richmond TS, Kauder D, Strumpf N, Meredith T: Characteristics and outcomes of serious traumatic injury in older adults. J Am Geriatr Soc. 2002, 50: 215-222. 10.1046/j.1532-5415.2002.50051.x.CrossRefPubMed

30.

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: 65-69.PubMed

31.

Lossius HM, Lund CG: Pre-hospital treatment of stroke - time is brain. Tidsskr Nor Laegeforen. 2012, 132: 1848-1849.CrossRefPubMed

Title: Improving adjustments for older age in pre-hospital assessment and care
Author: Marius Rehn
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2013
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/1757-7241-21-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Improving adjustments for older age in pre-hospital assessment and care

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2013

A structured approach to neurologic prognostication in clinical cardiac arrest trials

Confusion with cerebral perfusion pressure in a literature review of current guidelines and survey of clinical practise

Standard operating procedure changed pre-hospital critical care anaesthesiologists’ behaviour: a quality control study

Acute neuro-endocrine profile and prediction of outcome after severe brain injury

Publication of clinical trial protocols – what can we learn?

Treatment of penetrating trauma of the extremities: ten years’ experience at a dutch level 1 trauma center