Elderly patients with pelvic fracture: interventions and outcomes.

We examined the outcome of elderly trauma patients with pelvic fractures. Patients 65 years of age and older (elderly) with pelvic fractures were retrospectively compared with patients younger than 65 years with pelvic fractures and also with elderly patients without fracture. Over the study period, 1223 patients sustained a pelvic fracture (younger than 65 years, n=1066, 87.2%; elderly, n=157, 12.8%). These patients were also compared with 1770 elderly patients with blunt trauma without fracture. Although the pelvic fracture patients were equally matched for Injury Severity Score (21.2 +/- 13.4 nonelderly vs. 20.5 +/- 13.6 elderly), hospital length of stay was increased in the elderly (12.5 +/- 13.1 days vs. 11.5 +/- 14.1 days) and they had a higher mortality rate (20.4% [32 of 157] vs. 8.3% 88 of 10661). The elderly without fracture also had a higher mortality rate when compared with the younger patients (10.9% [191 of 1760]; P < 0.03). The elderly were more likely to die from multisystem organ failure (25.0% [eight of 32] vs. 10.2% [nine of 88]), whereas the nonelderly group was more likely to die from exsanguination (45.5% [40 of 88] younger than 65 years vs. 21.9% [seven of 32] 65 years or older; P < 0.05). Elderly patients with pelvic fracture have worse outcomes than their younger counterparts despite aggressive management at a Level I trauma center.

Detecting neuronal activity changes using an interspike interval algorithm compared with using visual inspection.

A universally accepted method for efficiently detecting neuronal activity changes (NACs) in neurophysiological studies has not been established. Visual inspection is still considered to be one of the most reliable methods, although it is limited when it is used for analyzing large quantities of data. In this study, an algorithm that considers interspike intervals (ISIs) was developed to define the onset of NACs. Two criteria, involving the mean and the standard deviation (S.D.) of the ISIs during a control period, were used in the ISI algorithm to evaluate the NACs that occurred during a detection period. The first, an ISI decrease of more than 1 S.D. from the mean ISI of the control period, proved to be an effective criterion for qualifying the increased NACs (firing rate increases). The second, an ISI increase greater than 3 S.D.s, efficiently demarcated periods of decreased NACs (firing rate decreases). Statistically significant correlations between the detection of NAC onset times by the ISI algorithm and the detection of those times by visual inspections were observed after offline analyses of recorded neuronal activity. The present results suggest that this ISI algorithm is a reliable and efficient way of defining the onset of NACs.