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Geriatric Trauma Patients at a Suburban Level-I Trauma Center in Japan

Published online by Cambridge University Press:  28 June 2012

Katsuhiko Sugimoto ,
Toru Aruga ,
Mitsuhiro Hirata  and
Masateru Shindo
Katsuhiko Sugimoto*
Affiliation:
Department of Emergency and Critical Care Medicine, Showa University School of Medicine, Tokyo, Japan
Toru Aruga
Affiliation:
Department of Emergency and Critical Care Medicine, Showa University School of Medicine, Tokyo, Japan
Mitsuhiro Hirata
Affiliation:
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Kanagawa, Japan
Masateru Shindo
Affiliation:
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Kanagawa, Japan
*
PhD Department of Emergency and Critical Care Medicine Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142–8666, Japan Tel: +81-3-3784-8744. FAX: +81-3-3784-6880 E-mail: [email protected]
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Abstract

Background:

Despite the increases in the aged population in Japan, there are little data on geriatric patients with traumatic injuries. A prospective clinical study was carried out to evaluate the use of the emergency medical services (emergency medical services) system, mechanisms of injury, and prehospital assessment and triage of elderly victims of trauma.

Patients and Methods:

From July 1996 through June 1997, a group of geriatric trauma (Group G, n = 22) and a control group of younger trauma patients (n = 173) were compared with respect to transfer method to an Emergency Center (direct or indirect), Revised Trauma Scores on the scene of the accident (revised trauma score-l) and on admission to the Emergency Center (revised trauma score-2), and outcome (survival).

Results:

The mean values for revised trauma score-l in the Control Group (Group C) were not different from those in Group G, but revised trauma score-2 of the indirect-transfer patients (indirectly transported patients) in Group G were significantly lower than were those for Group C. Group G mortality rates were significantly higher than were the control rates (p = 0.0001). The mortality rate of the indirectly transported patients subgroup was significantly lower than that of the direct transfer subgroup (directly transported patients) (30/68 vs. 5/70, p<0.0001) in the Group C, but mortality rate of the indirectly transported patients subgroup exceeded that of the directly transported patients subgroup of Group G (8/14 vs. 5/8).

Conclusion:

The data suggest that in geriatric-age patients, direct transfer patients have a lower mortality rate than do indirect transfer patients when controlled for injury severity score. Therefore, it seems that a different set of triage criteria should be developed and implemented for geriatric-age victims with trauma-induced injuries and that those who meet these more stringent criteria should be transferred directly to a Trauma Center.

Keywords

emergency centergeriatric traumaInjury Severity Score (injury severity score)mortalityprehospitalRevised Trauma Score (revised trauma score)triage systemtraumatrauma centertriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 14 , Issue 3 , September 1999 , pp. 79 - 83
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1999

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References

1. Champion, HR, Copes, WS, Buyer, D et al. : Major trauma in geriatric patients. AJPH 1989;79:1278–1282.Google Scholar
2. Oreskovich, MR. Howard, JD, Copass, NK et al. : Geriatric trauma: Injury patterns and outcome. J Trauma 1984;24:565–572.Google Scholar
3. Schwab, CW, Kauder, DR: Trauma in the geriatric patient. Arch Surg 1992;127:701–706.Google Scholar
4. Day, RJ, Vinen, J, Hewitt-Falls, E: Major trauma outcome in the elderly. Medical Journal of Australia 1994;160:675–678.CrossRefGoogle ScholarPubMed
5. Sapite, DW, Criss, EA, Valenzuela, TD et al. : Geriatric injury: An analysis of prehospital demographics, mechanisms, and patterns. Ann Enter Med 1990;19:1418–1421.CrossRefGoogle Scholar
6. Shapiro, MB, Dechart, RE, Volwel, C et al. : Geriatric trauma: Aggressive intensive care unit management is justified. Am Surg 1994;60:695–698.Google Scholar
7. Knudson, MM, Lieberman, J, Morris, JA et al. : Mortality factors in geriatric blunt trauma patients. Arch Surg 1994;129:448–453.CrossRefGoogle ScholarPubMed
8. Dekayser, F, Carolan, D, Trask, A: Suburban geriatric trauma: The experiences of a Level I Trauma Center. Am J Crit Care 1995;4:379–382.CrossRefGoogle Scholar
9. Phillip, S, Rond, PC III, Kelly, SM et al. : The failure of triage criteria to identify geriatric patients with trauma: Results from the Florida Trauma Triage Study. J Trauma 1996;40:278–283.CrossRefGoogle Scholar
10. American Association for Automotive Medicine: The Abbreviated Injury Scale, 1985 Revision, Arlington Heights IL 6005.Google Scholar
11. Baker, SP, O'Neil, B: The Injury Severity Score: An Update. J Trauma 1976;16 882–885.Google Scholar
12. Boyd, CR, Tolson, MA, Copes, WS: Evaluating trauma care: The TRISS Method. J Trauma 1987;27:370–381.CrossRefGoogle ScholarPubMed
13. Champion, HR, Copes, WS, Sacco, WJ et al. : The major trauma outcome study: Establishing national norms for trauma care. J Trauma 1990;30:1356–1452.CrossRefGoogle ScholarPubMed
14. Scalea, TM, Simon, HM, Duncan, AO et al. : Geriatric multiple trauma: Improved survival with early invasive monitoring. J Trauma 1990;30:129–136.CrossRefGoogle ScholarPubMed
15. DeMaria, EJ, Kenny, PR, Merriam, MA et al. : Survival after trauma in geriatric patients. Ann Surg 1987;206:738–743.CrossRefGoogle ScholarPubMed
16. Schiller, WR, Knox, R, Chleboard, W: A five year experience with severe injuries in elderly patients. Accid Anl and Prev 1995;27:167–174.CrossRefGoogle ScholarPubMed
17. Finelli, FC, Johnson, J, Champion, HR et al. : A case control study for major trauma in geriatric patients. J Trauma 1989;29:541–548.CrossRefGoogle ScholarPubMed
18. Levy, DB, Hanlon, DP, Townsend, RN: Geriatric trauma. Clinics in Geriatric Medicine 1993;9:601–620.Google Scholar