Subject(s)
Accreditation/organization & administration , Governing Board/organization & administration , Local Government , Public Health Administration/standards , Centers for Disease Control and Prevention, U.S./organization & administration , Communication , Cooperative Behavior , Governing Board/standards , Humans , Leadership , United StatesSubject(s)
Local Government , Obesity/prevention & control , Public Health , State Government , HumansABSTRACT
INTRODUCTION: The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims. METHODS: A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria. RESULTS: The following criteria were identified as geriatric-specific criteria: (1) GCS score <14 in the presence of known or suspected traumatic brain trauma; (2) SBP <100 mmHg; (3) fall from any height with evidence of traumatic brain injury: (4) multiple body-system injuries; (5) struck by a moving vehicle; and (6) the presence of any proximal long bone fracture following motor vehicle trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center. CONCLUSIONS: The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the overall mortality in the elderly.
Subject(s)
Emergency Medical Services/organization & administration , Geriatric Assessment/methods , Triage/standards , Wounds and Injuries/diagnosis , Age Factors , Aged , Comorbidity , Emergency Medical Services/standards , Evidence-Based Emergency Medicine , Glasgow Coma Scale , Humans , Ohio , Registries , Risk Assessment , Wounds and Injuries/mortalityABSTRACT
People with Medicaid or no dental insurance have a difficult time accessing dentists in private practice. The problem of access is more profound in rural than urban areas. Safety net dental clinics operated by small rural local health districts are difficult to start up, operate, and maintain. The number of these facilities in the United States is small and not evenly distributed to meet needs. This article describes how a full-service dental clinic was established to serve six rural county health districts in Northwest Ohio. Retired volunteer dentists were instrumental in the success of creating the clinic, starting with a field-type operation in 2001 serving 316 persons and building into a full-time regional dental center that served 1,306 individuals in 2007.
Subject(s)
Dental Clinics/organization & administration , Rural Health Services/organization & administration , Adolescent , Adult , Child , Child, Preschool , Female , Health Services Accessibility , Human Experimentation , Humans , Male , Medicaid , Medically Uninsured , Needs Assessment , Ohio , Poverty , United States , WorkforceABSTRACT
OBJECTIVES: The chosen age cutoff for considering patients with trauma to be "elderly" has ranged from 55 to 80 years in trauma guidelines and studies. The goal of this study was to identify at what age mortality truly increases for older victims of trauma. METHODS: We performed a cross-sectional study of the Ohio Trauma Registry, a statewide database of all injured patients who died or were admitted for more than 48 hours to both trauma and nontrauma centers. Patients 16 years or older entered into the registry between January 1, 2003, and December 31, 2006, were included. Inhospital mortality rates were obtained and stratified by 5-year age intervals and by injury severity score (ISS). Rates between age groups were compared using logistic regression to identify significant differences in mortality. RESULTS: Included were 75 658 patients. In logistic regression, patients 70 to 74 years of age had significantly greater mortality than all younger age groups when stratified by ISS (P < or = .001-.004). When considering other 5-year age groups as referent (40-44, 45-49, 50-54, 55-59, 60-64, 65-69 years old), no other group was associated with significantly increased mortality, as compared to younger groups (P > .05 for all). CONCLUSION: Patients 70 to 74 years of age have significantly greater mortality than all younger age groups when stratified by ISS. Age cutoffs based on younger ages are not associated with significant increases in mortality. An age of 70 years should be considered as an appropriate cutoff for considering a patient to be elderly in future studies of trauma and development of geriatric trauma triage criteria.
