Trauma Recidivism in an Aging Population: Who Is Most at Risk?

Background: Repeated episodes of trauma, particularly in older adults, result in increased morbidity and mortality. This study investigates trauma recidivism in our adult population to identify which patients in our region are more likely to become recidivists. Materials and Methods: This 4 year retrospective study (2013 to 2017) examines all patients 18 years of age or older with multiple hospital admissions for trauma, comparing patients ages 65 and older (older adults) to those ages 18 to 64 (younger adults). Exclusion criteria consisted of those younger than 18 and/or had a home zip code outside of the study region. Data included admission demographics, injury characteristics and other clinical metrics. Results: There were 240 younger adult and 182 older adult trauma recidivists included. In total, 4% of all patients were recidivists with significantly higher rates of recidivism among older adults (OR: 1.94 [1.59-2.36], p <0.001). Older adult recidivists were more likely to be female (OR: 4.28 [2.82-6.51], p <0.001) and suffer blunt trauma secondary to a fall (OR: 5.36 [3.91-7.35], p <0.001). Trauma recidivism in older adults also correlated with a higher Injury Severity Score, longer length of stay and an increased proportion of patients requiring to be discharged home with organizational help or to a rehabilitation facility. Conclusions: Trauma can be recurrent and associated with poor health outcomes, particularly in older adults. Recidivists in the studied region were significantly older with the most at-risk population consisting of females suffering blunt injury secondary to a fall. Improved prevention strategies are needed for this population.

Epidemiological overview - 18 years of ICU hospitalization due to trauma in Brazil / Panorama epidemiológico de dezoito anos de internações por trauma em UTI no Brasil

ABSTRACT OBJECTIVE Assess the magnitude and trend of hospitalization rates due to traumatic injuries in intensive care units (ICU) in Brazil from 1998 to 2015. METHODS This is an ecological time-series study that analyzed data from the Hospital Information System. A trend analysis of hospitalization rates was performed according to diagnosis, sex and age using generalized linear regression models and Prais-Winsten estimation. RESULTS Rates were higher among male patients, but increased hospitalization due to trauma among female patients influenced the ratio between both sexes. Falls and transport accidents were the most frequent causes of trauma. The average annual growth was 3.6% in ICU trauma hospitalization rates in Brazil, the highest growth was reported in the North region (8%; 95%CI 6.4-9.6), among women (5.4%; 95%CI 4.5-6.3), and among people aged 60 years and older (5.5%; 95%CI, 4.7-6.3). The most frequent causes of trauma are falls (4.5%; 95%CI 3.5-5.5) and care complications (5.4%; 95%CI 4.5-6.3). On the other hand, the annual hospital mortality rate due to trauma in ICU is 1.7% lower, on average (95%CI 2.1-1.3). CONCLUSION An increase in ICU hospitalization rate due to trauma in Brazil may be the result of some factors, such as an increasing number of accidents and cases of violence, the implementation of pre-hospital care, and improved access to care, with more beds in ICU. In addition, population aging is another factor, as a greater increase in hospitalization was observed among people aged 60 years and older.

RESUMO OBJETIVO Analisar a magnitude e a tendência das taxas de internação por lesões traumáticas em unidades de terapia intensiva (UTI) no Brasil de 1998 a 2015. MÉTODOS Estudo ecológico de séries temporais com dados do Sistema de Informações Hospitalares. A análise de tendência das taxas de internação segundo diagnóstico, sexo e idade foi realizada por modelos de regressão linear generalizada e procedimento de Prais-Winsten. RESULTADOS As taxas foram mais elevadas para os homens, mas o crescimento das internações por trauma para as mulheres influenciou a razão das taxas entre os sexos. As quedas e os acidentes de transporte foram as causas mais frequentes dos traumas. Houve aumento de 3,6% ao ano, em média, nas taxas de internação por trauma em UTI no Brasil, maior na região Norte (8%; IC95% 6,4-9,6), entre as mulheres (5,4%; IC95% 4,5-6,3) e pessoas com 60 anos ou mais (5,5%; IC95% 4,7-6,3). Entre as causas do trauma, as quedas (4,5%; IC95% 3,5-5,5) e complicações assistenciais (5,4%; IC95% 4,5-6,3) foram as mais importantes. Por outro lado, as taxas de mortalidade hospitalar por trauma em UTI declinaram 1,7% ao ano, em média (IC95% 2,1-1,3). CONCLUSÃO O aumento das internações por trauma em UTI no Brasil pode ser resultado de alguns fatores, como a ocorrência crescente de acidentes e violências, a implementação do atendimento pré-hospitalar e também a melhoria no acesso à assistência, com maior número de leitos em UTI. Soma-se a isso o envelhecimento da população, pois observou-se aumento mais acentuado das internações em pessoas com 60 anos de idade ou mais.

Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms / Avaliação do Escore de Trauma Revisado (RTS) em 200 vítimas de trauma com mecanismos diferentes

ABSTRACT Objective: to analyze the epidemiological profile and mortality associated with the Revised Trauma Score (RTS) in trauma victims treated at a university hospital. Methods: we conducted a descriptive, cross-sectional study of trauma protocols (prospectively collected) from December 2013 to February 2014, including trauma victims admitted in the emergency room of the Cajuru University Hospital. We set up three groups: (G1) penetrating trauma to the abdomen and chest, (G2) blunt trauma to the abdomen and chest, and (G3) traumatic brain injury. The variables we analyzed were: gender, age, day of week, mechanism of injury, type of transportation, RTS, hospitalization time and mortality. Results: we analyzed 200 patients, with a mean age of 36.42 ± 17.63 years, and 73.5% were male. The mean age was significantly lower in G1 than in the other groups (p <0.001). Most (40%) of the visits occurred on weekends and the most common pre-hospital transport service (58%) was the SIATE (Emergency Trauma Care Integrated Service). The hospital stay was significantly higher in G1 compared with the other groups (p <0.01). Regarding mortality, there were 12%, 1.35% and 3.95% of deaths in G1, G2 and G3, respectively. The median RTS among the deaths was 5.49, 7.84 and 1.16, respectively, for the three groups. Conclusion: the majority of patients were young men. RTS was effective in predicting mortality in traumatic brain injury, however failing to predict it in patients suffering from blunt and penetrating trauma.

RESUMO Objetivo: analisar o perfil epidemiológico e a mortalidade associada ao escore de trauma revisado (RTS) em vítimas de trauma atendidas em um hospital universitário. Métodos: estudo transversal descritivo de protocolos de trauma (coletados prospectivamente) de dezembro de 2013 a fevereiro de 2014, incluindo vítimas de trauma admitidas na sala de emergência do Hospital Universitário Cajuru. Três grupos foram criados: (G1) trauma penetrante em abdome e tórax, (G2) trauma contuso em abdome e tórax, e (G3) trauma cranioencefálico. As variáveis analisadas foram: sexo, idade, dia da semana, mecanismo de trauma, tipo de transporte, RTS, tempo de internamento e mortalidade. Resultados: analisou-se 200 pacientes, com média de idade de 36,42 ± 17,63 anos, sendo 73,5% do sexo masculino. A média de idade no G1 foi significativamente menor do que nos demais grupos (p <0,001). A maioria (40%) dos atendimentos ocorreu nos finais de semana e o serviço de transporte pré-hospitalar mais frequente (58%) foi o SIATE (Serviço Integrado de Atendimento ao Trauma em Emergência). O tempo de internamento foi significativamente maior no G1, em comparação aos demais grupos (p <0,01). Quanto à mortalidade, houve 12%, 1,35% e 3,95% de óbitos nos grupos G1, G2 e G3, respectivamente. A mediana do RTS entre os óbitos foi 5,49, 7,84 e 1,16, respectivamente, para os três grupos. Conclusão: a maioria dos pacientes eram homens jovens. O RTS mostrou-se efetivo na predição de mortalidade no trauma cranioencefálico, entretanto falhou ao analisar pacientes vítimas de trauma contuso e penetrante.

Epidemiología de los Accidentes de Transito en el Hospital Nacional. Itauguá Paraguay / Epidemiology of Traffic Accidents in the Nacional Hospital. Itauguá Paraguay

RESUMEN Objetivo:Determinar las características epidemiológicas de pacientes con accidentes de tránsito (AT) asistidos en las áreas de urgencias del Hospital Nacional durante el mes de enero del 2009 y enero a mayo del 2010.Material y Métodos:Estudio epidemiológico retrospectivo y prospectivo. Los datos fueron obtenidos de diferentes fuentes como planígrafos de las salas de urgencias, estadísticas hospitalarias, expedientes clínicos, entrevistas con familiares de accidentados.Resultados:Consultaron 303 adultos y 50 niños con accidentes de tránsito. La procedencia más frecuente fueron Itá e Itauguá. La prevalencia de accidentes en enero del 2009 fue de 4,8% igual que en enero del 2010 en adultos, en tanto que en niños fue del 0,8 %. El grupo etáreo más frecuente en niños fue entre 13 y 16 años y de 16 a 23 años en urgencias de adultos. Predominó el sexo masculino, ocurrió con mayor frecuencia los sábados y domingos, entre 18:00 a 24:00 hs. El tipo de transporte más utilizado fue motocicleta, preferentemente choques y caídas. No se pudo obtener datos en un porcentaje elevado sobre uso de casco, consumo de alcohol y tipo de accidente. Las regiones corporales más afectadas fueron cráneo y miembros inferiores. La letalidad osciló entre 2 y 4%.Conclusiones: Los accidentes de tránsito predominaron en personas jóvenes del sexo masculino, ocurrieron los fines de semana, involucraron el uso de motocicletas, afectaron la región cefálica y miembros inferiores. La letalidad osciló entre 2 y 4%.

ABSTRACT Objective: To determine the epidemiological characteristics of patients with traffic accidents (TA) assisted in the emergency areas of the National Hospital during the month of January 2009 and May 2010. Materials and Methods: Retrospective and prospective epidemiological study. Data were obtained from different sources such as the hospital statistics, medical records, interviews with relatives of cases. Results: we consulted 303 adults and 50 children to traffic accidents. The most common origin was Itaugua and Ita. The prevalence of accidents in January 2009 was 4.8% as in January 2010 in adults, while in children was 0.8%. The most frequent age group was between 13 and 16 years in boys and from 16 to 23 years in adult emergency department. The male was most often on Saturdays and Sundays between 18:00 to 24:00. The type of transport used was motorcycle preference shocks and falls. We could not get data at a rate high on helmet use, alcohol consumption and type of accident. The body regions most affected was the skull and lower limbs. The mortality ranged from 2 to 4%. Conclusions: The predominant traffic accidents were in male young people, occurred at the weekend, involved the use of motorcycle, injuring the cephalic region and lower limbs.The mortality ranged from 2 to 4%.