Injury patterns in elderly cyclists and motorcyclists presenting to a tertiary trauma centre in Singapore

INTRODUCTION@#With Singapore's ageing population, there are increasing numbers of elderly cyclists and motorcyclists. Compared to younger riders, this cohort sustains more injuries and has poorer outcomes. This study aimed to describe and compare patient demographics, injury patterns and outcomes among elderly cyclists and motorcyclists at a Level 1 trauma centre.@*METHODS@#Data of all cyclists, motorcyclists and pillion riders aged 65 years and above who presented to the emergency department after accidents from 1 January 2013 to 31 December 2017 was extracted from the hospital's trauma registry and reviewed.@*RESULTS@#Cyclists and motorcyclists formed 42.0% and 58.0%, respectively, of 157 recruited patients. At the time of the accident, 40.8% of the patients were employed. The mean age of the patients was 71.6 ± 5.8 years. Extremities and pelvic girdle injuries (61.1%) were the most frequent, followed by chest injuries (48.4%), and head and neck injuries (40.1%). Among severe injuries (defined as Abbreviated Injury Scale score ≥ 3), chest injuries (39.5%) were the most common, followed by head and neck injuries (36.3%). The overall mortality rate was 9.6%, with cyclists at nearly three times the risk compared to motorcyclists. More cyclists than motorcyclists (18.2% vs. 11.0%) required intensive care. There were no significant differences in the length of hospital stay between cyclists and motorcyclists.@*CONCLUSION@#Elderly riders have unique injury patterns and consume significant healthcare resources. Trauma systems need to acknowledge this changing injury epidemiology and equip trauma centres with the necessary resources targeted at elderly patients. Future work should focus on strategies to minimise extremity and chest injuries.

What's new in trauma 2020 / 中华创伤杂志(英文版)

Throughout the past 2020, the pandemic COVID-19 has caused a big global shock, meanwhile it brought a great impact on the public health network. Trauma emergency system faced a giant challenge and how to manage trauma under the pandemic of COVID-19 was widely discussed. However, the trauma treatment of special population (geriatric patients and patients taking anticoagulant drugs) has received inadequate attention. Due to the high mortality following severe traumatic hemorrhage, hemostasis and trauma-induced coagulopathy are the important concerns in trauma treatment. Sepsis is another topic should not be ignored when we talking about trauma. COVID-19 itself is a special kind of sepsis, and it may even be called as serious systemic infection syndrome. Sepsis has been become a serious problem waiting to be solved urgently no matter in the fields of trauma, or in intensive care and infection, etc. This article reviewed the research progress in areas including trauma emergency care, trauma bleeding and coagulation, geriatric trauma and basic research of trauma within 2020.

Traumatismo torácico en el adulto mayor / Thoracic trauma in the elderly

Resumen Introducción: Los traumatismos constituyen la quinta causa de muerte en el adulto mayor (60 años o más), siendo los traumatismos contusos los más frecuentes. Objetivo: Describir características, índices de gravedad de traumatismo (IGT), morbilidad y mortalidad en adultos mayores (AM) hospitalizados con traumatismo torácico (TT). Materiales y Método: Estudio descriptivo transversal. Período desde enero de 1981 a diciembre de 2017. Revisión de base de datos, protocolos quirúrgicos y fichas clínicas. Descripción de características de TT en AM hospitalizados. Se calculó IGT: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.163 TT, AM 513 (12,3%). Hombres: 350 (68,2%), edad promedio 71,2 ± 8,4 años, mediana 70 (rango: 60-103), TT aislado 350 (68,2%), asociado a lesiones extratorácicas 163 (31,8%) y de estos 96 (18,7%) se consideraron politraumatismos. Traumatismo contuso 456 (88,9%) y penetrante 57 (11,1%). La causa más frecuente fueron las caídas en 252 (49,1%). Lesiones y/o hallazgos torácicos más frecuentes: fracturas costales 409 (79,7%), hemotórax 186 (36,3%) y neumotórax 185 (36,1%). Tratamiento definitivo: médico 287 (55,9%), pleurotomía 193 (37,6%) y cirugía 40 (7,8%). Cirugía extratorácica 33 (6,4%). Hospitalización promedio 9,0 ± 8,8 días. Según IGT: ISS promedio 12,1 ± 9,6, RTS-T promedio 11,6 ± 1,3, TRISS promedio 8,1. Morbilidad 76 (14,8%) y mortalidad 26 (5,1%). Discusión: La mayoría de los TT en AM son contusos, causados por accidentes domésticos. Las lesiones y hallazgos más frecuentes fueron fracturas costales y hemotórax. La mortalidad fue menor a la esperada según IGT.

Introduction: Trauma is the fifth leading cause of death in the elderly (60 or older), with blunt trauma being the most frequent. Objective: To describe characteristics, Trauma Severity Indices (TSI) and morbidity and mortality in hospitalized elderly for Thoracic Trauma (TT). Materials and Method: Crosssectional descriptive study was carried out. Term: from January 1981 to December 2017. Database review, surgical protocols and medical records were performed. TT description of characteristics was conducted in hospitalized elderly. TSI was calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Results: Total 4.163 TT, 513 elderly (12.3%). Men: 350 (68.2%), average age 71.2 ± 8.4 years, 70 median (range 60-103). Isolated TT: 350 (68.2%), 163 associated with extrathoracic trauma (31.8%) and of these 96 (18.7%) were considered polytraumatism. Blunt trauma 456 (88.9%) and penetrating 57 (11.1%). Most frequent domestic accident mechanism was 196 (38.2%) and 158 traffic accidents (30.8%). Frequently thoracic injuries or findings: 409 rib fractures (79.7%), 186 hemothorax (36.3%), and 185 pneumothorax (36.1%). Final treatment: 287 Medical treatment (55.9%), 193 pleurotomy (37.6%), and 40 thoracic surgery (7.8%). Extrathoracic surgery 33 (6.4%). Average hospitalization: 9.0 ± 8.8 days. According IGT: ISS 12.1 ± 9.6, RTS-T 11.6 ± 1.3, TRISS 8.1. Morbidity: 76 (14.8%) and mortality: 26 (5.1%). Discussion: Most TT in elderly are blunt, caused by domestic accidents. Injuries and most frequent findings were rib fractures and hemothorax. Mortality was lower than expected according to TSI.

Advance in Geriatric Traumatic Spinal Cord Injury (review) / 中国康复理论与实践

The incidence and proportion of traumatic spinal cord injury in the elderly are increasing year by year, and it has become the main affected population of spinal cord injury in developed countries. Fall is the main cause of injury. The increase of spinal stenosis, the biomechanical changes of the spine and the hyperextension injuries may be the mechanism of spinal cord injury caused by minor trauma in this population. Traumatic spinal cord injury in the elderly usually requires early surgical treatment. When there are complicated comorbidities, unstable vital signs or mild spinal cord injury without major fracture or dislocation, non-surgical treatment and active rehabilitation can be considered. However, the specific indications and timing of surgery are still controversial. Compared with young people, most elderly patients present with incomplete cervical spinal cord injury and are expected to restore better limb function, following poor recovery of self-care ability. It is important to monitor the functional change throughout rehabilitation and adjust the hours and intensity of training accordingly.

The Influence of the Regional Weather in Geriatric Trauma

PURPOSE: Many factors influence the occurrence and severity of geriatric trauma, and regional weather is regarded as one factor that influences geriatric trauma. In this study, to predict the type, severity, and incidence of geriatric trauma patient, we analyzed the influence of regional weather on geriatric trauma. METHODS: The subjects of our investigation were trauma patients over sixty-five years of age who visited the Emergency Department (ED) of Yeungnam University Hospital during a one-year period. We retrospectively reviewed the medical charts of 436 geriatric trauma patients, and the data were analyzed by using SPSS 12.0 for Window. The weather was based on data from the Korea Meteorological Administration. RESULTS: The average age was 72.8 years old, and the ratio of males to females was 1:1.1. The mean spell out ISS was 10.8, and no difference was found between males and females. Slips were the most common cause of trauma. The largest numbers of aged trauma patients, 46, visited the ED in May, and the smallest number of such patients, 24, visited the ED in December. In addition to, summer saw the largest number of aged trauma patients. The type of trauma, the Injury Severity Score, and the number of patients had no relationship with season. On sunny days, the ISS was larger in patients who had hypotension and who had tachycardia. On rainy day, the ISS was larger in male patients and cultivator accident patients. The number of patients was larger on partly cloudy days. CONCLUSION: In spring and summer and on partly cloudy days, we must be prepared to treat aged traumatized patients in the E.D. On rainy days, visual sensation, tactual sense, and acoustic sense must be closely examined. In addition,on rainy day, aged male traumatized patients or cultivator accident patients must to be closely observation.

The Influence of the Regional Weather in Geriatric Trauma

PURPOSE: Many factors influence the occurrence and severity of geriatric trauma, and regional weather is regarded as one factor that influences geriatric trauma. In this study, to predict the type, severity, and incidence of geriatric trauma patient, we analyzed the influence of regional weather on geriatric trauma. METHODS: The subjects of our investigation were trauma patients over sixty-five years of age who visited the Emergency Department (ED) of Yeungnam University Hospital during a one-year period. We retrospectively reviewed the medical charts of 436 geriatric trauma patients, and the data were analyzed by using SPSS 12.0 for Window. The weather was based on data from the Korea Meteorological Administration. RESULTS: The average age was 72.8 years old, and the ratio of males to females was 1:1.1. The mean spell out ISS was 10.8, and no difference was found between males and females. Slips were the most common cause of trauma. The largest numbers of aged trauma patients, 46, visited the ED in May, and the smallest number of such patients, 24, visited the ED in December. In addition to, summer saw the largest number of aged trauma patients. The type of trauma, the Injury Severity Score, and the number of patients had no relationship with season. On sunny days, the ISS was larger in patients who had hypotension and who had tachycardia. On rainy day, the ISS was larger in male patients and cultivator accident patients. The number of patients was larger on partly cloudy days. CONCLUSION: In spring and summer and on partly cloudy days, we must be prepared to treat aged traumatized patients in the E.D. On rainy days, visual sensation, tactual sense, and acoustic sense must be closely examined. In addition,on rainy day, aged male traumatized patients or cultivator accident patients must to be closely observation.

Clinical Review In Geriatric Trauma Patients

PURPOSE: This study was conducted to examine various clinical factors for their ablity to predict mortality in geriatric patients following trauma. METHODS: In this retrospective study, medical records from Chun Cheon Sacred Heart hospital were reviewed for patients 65 years and older who sustained trauma. The following variables were extracted and examined, independently and in combination, for their ablity to predict death: age, gender, mechanism of injury, blood pressure, and respiration, pulse rate, as well as Glasgow Coma Score, Revised Trauma Score, and Injury Severity Score. These patients had entered the hospital following trauma during a 2-year period (1999-2000). RESULTS: the Injury Severity Score (more than 28), the Glasgow Coma Score (less than 9), and the Revised Trauma Score (less than 8) were variables that correlated with mortality. Mortality rates were higher for men than for women. Admission variables associated with the highest risks of death included hypotension (mean blood pressure < 78 mmHg); pedestrian and motorcycle traffic accident; skull fracture, subdural hemorrhage, and diffuse axonal injury; and hemothorax and lung contusion. CONCLUSION: Admission variables in geriatric trauma patients can be used to predict the outcome and may also be useful in making decisions about triage, and treatment of the patient.

Clinical Significance of the Triage-revised Trauma Score in the Triage of Geriatric Trauma Patients

BACKGROUNDS: The mortality of geriatric trauma patients is higher than that of other age groups. However, little research has been done the methods or criteria of triage for geriatric trauma patients. This study evaluated a clinical significance of the triage-revised trauma score(t-RTS) for triage of geriatric trauma patients. METHODS: We retrospectively analyzed clinical data on 528 trauma patients over 65 years of age who were treated from Jan 1999 to Dec 2000. The t-RTS was calculated utilizing the RR(respiratory rate), SBP(systolic BP), and GCS scores and the ISS was abstracted from the final diagnosis. The obtained t-RTS and ISS were evaluated using the measures of sensitivity, specificity, accuracy, and AUC curve. RESULTS: The overall mortality rate was 9%, and there was no significant differences between the survival group and the mortality group according to age and sex. The mean scores of SBP, RR and GCS of the survival group were significantly higher than those of mortality group(p=0.001). The mean of t-RTS and RTS of the survival group were also significantly higher(p=0.001), but the ISS was significantly higher in the mortality group(p=0.001). The t-RTS, RTS, and ISS showed good prediction rates on the ROC curve(p=0.001), and the AUC value was higher in the ISS than in the t-RTS and the RTS. The sensitivity and the accuracy were high in the t-RTS and the RTS, and the specificity was high in the ISS. The t-RTS is less than 10 for a survival probability of 50% or less CONCLUSONS: Implementation of the t-RTS in the triage of geriatric trauma patients in the field and in emergency room would be very useful. The probability of death in geriatric trauma patients is high when the t-RTS is less than 10.