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Management Perspectives
Multiple trauma in the elderly is increasing with
the aging population
Summary
Diminished physiological reserve and the existence
of multiple medical comorbidities present
additional challenges to management
Summary
The elderly comprise the fastest growing segment
of the US population.
2009 : 12.9% of the population was aged 65 years
and older(The US Census Bureau reported )
2050 : the population will reach 20.1% of the
total
Introduction
Number of elderly trauma victims will also
increase
motor vehicle collisions
pedestrians struck by motor vehicles
falls from a height
crush injuries
Introduction
The elderly have diminished physiological reserve
and often multiple medical comorbidities
Despite these factors, survival to discharge rates
of over 50% have been reported
The purpose of this review is to identify and
address the challenges of caring for the multiply
injured elderly patient and to update management
strategies
Introduction
Richmond et al (Pennsylvania Trauma Systems
Foundation)
Injuries were sustained by
fall in 61.7%
motor vehicle crash in 22.6%
other 9.4%
pedestrian in 4.6%
hit by object in 0.9%
assault in 0.8%
Mechanisms & Types of
Injury
The body region with the most severe injury
extremity/pelvic girdle 47.4%
head/neck at 22.1%,
chest/thorax at 16.0%
external/skin at 7.6%,
abdomen/pelvic contents at 4.5%,
face at 2.3%.
Triage, Initial
Evaluation, and Care
Meldon et al:
retrospective cohort study
Triage, Initial
Evaluation, and Care
Zimmer et al :
retrospective analysis of all admissions for
acute trauma in a 2.5-year period
severely injured elderly patients, especially
females, are at risk for undertriage
current triage protocols may be inadequate
for assessing the severity of injury in the
elderly trauma patient
Triage, Initial
Evaluation, and Care
Possibly the most important thing to
recognize is that normal presenting vital
signs are not reassuring in elderly
trauma patients
Triage, Initial
Evaluation, and Care
Heffernan et al :
cohort study to determine the impact of
abnormal presenting vital signs on mortality
Triage, Initial
Evaluation, and Care
Early intensive management and
resuscitation efforts can improve survival of
the elderly trauma patient
Triage, Initial
Evaluation, and Care
Demetriades et al:
Triage, Initial
Evaluation, and Care
McKinley et al:
Triage, Initial
Evaluation, and Care
Scalea et al :
Triage, Initial
Evaluation, and Care
Intensive monitoring, early intensive care
unit admission, and goal-directed
resuscitation are recommended in the
elderly trauma patient
Triage, Initial
Evaluation, and Care
Markers for resuscitation
HR, BP, urine output
can be unreliable in the elderly due to
hypertension,
use of beta-blockers,
pre-existing organ dysfunction
Triage, Initial
Evaluation, and Care
Base deficit and serum lactate levels may
be better guides to assess tissue perfusion
and cellular oxygenation
Triage, Initial
Evaluation, and Care
Pre-existing medical conditions are
associated with worse outcomes in geriatric
trauma patients
Grossman et al :
Hepatic disease, renal disease, cancer,
and congestive heart failure were found to
have the strongest associations with
mortality
Pre-existing Medical
Conditions
Perdue et al:
had similar findings with pre-existing
cardiovascular or liver disease, renal, or
infectious complications.
Tornetta et al :
Delay in fixation in physiologically stable
patients has been shown to increase
morbidity and mortality
CONCLUSIONS
Appropriate triage
recognition of hypotension & hypoperfusion,
despite normal or near normal vital signs on
presentation
early intensive monitoring and resuscitation
= improves survival