Management of Geriatric Trauma: General Overview

Year 2019, Volume: 2 Issue: 4, 32 - 36, 31.12.2019

Abdullah Algın , Serkan Emre Eroğlu

Abstract

According to the Turkish Statistical Institute (TSI), the Turkish geriatric population (aged 65 and above) increased from 5,682,000 in 2012 to 6,651,000 in 2016. This represents an increase of 17.1%. With respect to this information, geriatric trauma cases in Turkey are likely to increase over the coming years. Though this is unlikely to transform conventional medical approaches to trauma in geriatric patients, extra attention must be paid to this population’s hidden trauma and complications secondary to reduced physiological reserves. When applying the basic principles of primary and secondary assessment in trauma management, myriad factors contribute to this need for additional caution when treating the elderly.

Medications, history of allergies, and the identification of any accompanying chronic diseases are just a few of the multiple factors that must be considered when managing elderly patients. Furthermore, patients' general health statuses prior to the trauma and accompanying medical histories should be evaluated alongside any prior tests such as ECGs or blood sugar measurements.

To summarize, geriatric patients must undergo general physical examination and factors affecting diagnosis, treatment, and process management must be analyzed and accounted for. The health of geriatric patients may deteriorate rapidly and without warning, even when it appears stable. This represents a unique challenge with this patient group and must not be overlooked.

Keywords

Geriatric, Trauma, Management

Geriyatrik Travma Yönetimi: Genel Bakış

Abstract

Türkiye İstatistik Kurumu (TÜİK) verilerine göre; 2012 yılında 5 milyon 682 bin olan yaşlı nüfus (65 yaş ve yukarı yaş) 2016 yılına kadarki süreçte %17,1 artarak 6 milyon 651 bin olmuştur. Bu bilgiler ışığında yaşlanmakta olan ülkemizde daha fazla oranda geriatrik travma örnekleri ile karşılaşacağımızı öngörebiliriz. Bu durum ise, travmaya genel yaklaşım açısından, diğer yaş gruplarıyla aralarında belirgin fark yaratmasa da, azalmış fizyolojik reserve ikincil sorunlar ve olası gizli travmalar açısından dikkati gerektirir. Travma yönetiminin temellerinde yatan birincil ve ikincil bakıya ait kurallar aynen uygulanırken sergilenmesi gereken bu dikkat gereksinimini ortaya çıkaran pek çok faktör vardır.

Kullanılan ilaçlar, alerji öyküsü olup olmaması, eşlik eden bir kronik hastalıkların bilinmesi, bu hastaların yönetimi sırasında gözönüne alınan faktörlerden sadece birkaçıdır. Yine, travma öncesi son sağlık durumu travmanın etiyolojisinde rol oynayabileceğinden; eşlik eden hastalık öyküsü ve/veya eski elektrokardiyografi, kan şekeri değeri gibi kayıtlar da gözden geçirilmesi gerekenler arasındadır.

Sonuç olarak, geriatrik travma hastalarına dikkatle genel fizik muayene yapılıp, tanı-tedavi ve süreç yönetimini etkileyebilecek faktörler değerlendirilmelidir. Özellikle yaşlı popülasyonda stabil gibi görünen hastaların, çok kısa bir sürede ve erken bir uyarıcı semptom olmadan kötüleşebileceği unutulmamalıdır.

Keywords

Geriyatri, Travma, Yönetim

References

• 1. Kramarow E, Chen L, Hedegaard H, Warner M. Deaths from unintentional injury among adults aged 65 and over: United States, Hyattsville, MD: National Center for Health Statistics; 2015.
• 2. Joyce MF, Gupta A, Azocar RJ. Acute trauma and multiple injuries in the elderly population. Curr Opin Anaesthesiol. 2015;28:145–50.
• 3. Min L, Burruss, S, Morley E, et al. A simple clinical risk nomogram to predict mortality-associated geriatric complications in severely injured geriatric patients. J Trauma Acute Care Surg. 2013;74:1125–32.
• 4. Colwell C. Geriatric trauma: Initial evaluation and management. Web site. Available at: https://www.uptodate.com/contents/geriatric-trauma-initial-evaluation-and-management. Accessed December 22,2019.
• 5. Martin JT, Alkhoury F, O’Connor JA, et al. Normal vital signs belie occult hypoperfusion in geriatric trauma patients. Am Surg. 2010;76:65–9.
• 6. McGwin G, MacLennan PA, Fife JB, et al. Preexisting conditions and mortality in older trauma patients. J Trauma. 2004;56:1291–6.
• 7. Wang H, Coppola M, Robinson RD, et al. Geriatric trauma patients with cervical spine fractures due to ground level fall: five years experience in a level one trauma center. J Clin Med Res. 2013;5:75–83.
• 8. Keenan NL, Rosendorf KA. Prevalence of hypertension and controlled hypertension – United States, 2005–2008. Morb Mortal Wkly Rep. 2011;60:94–7.
• 9. Kennedy RD, Caird FI. Physiology of the aging heart. Cardiovasc Clin. 1981;12:1–8.
• 10. Bradburn E, Rogers FB, Krasne M, et al. High-risk geriatric protocol: improving mortality in the elderly. J Trauma Acute Care Surg. 2012;73:435–40.
• 11. Ferrera PC, Bartfield JM, D’Andrea CC. Outcomes of admitted geriatric trauma victims. Am J Emerg Med. 2000;18:575–80.
• 12. Joseph B, Pandit V, Khalil M, et al. Managing older adults with ground-level falls admitted to a trauma service: the effect of frailty. J Am Geriatr Soc. 2015;63:745–9.
• 13. Stevens JA. Fatalities and injuries from falls among older adults—United States 1993–2003 and 2001–2005. MMWR Morb Mortal Wkly Rep. 2006;55:1221–24.
• 14. Murray D, Dodds C. Perioperative care of the elderly. Contin Educ Anaesth Crit Care Pain. 2004;4:193–6.
• 15. Johnson KN, Botros DB, Groban L, Bryan YF. Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management. Clinical interventions in aging. 2015;10:1925.
• 16. Kanonidou Z, Karystianou G. Anesthesia for the elderly. Hippokratia. 2007;11:175.
• 17. Lewis MC, Abouelenin K, Paniagua M. Geriatric trauma: special considerations in the anesthetic management of the injured elderly patient. Anesthesiology clinics. 2007;25:75-90.
• 18. Cook DJ, Rooke GA. Priorities in perioperative geriatrics. Anesth Analg. 2003;96:1823–36.
• 19. Richter T, Ragaller M. Ventilation in chest trauma. Journal of Emergencies, Trauma and Shock. 2011;4:251.
• 20. Chiumello D, Coppola S, Froio S, et al. Noninvasive ventilation in chest trauma: systematic review and meta-analysis. Intensive care medicine. 2013;39:1171-80.
• 21. Strait JB, Lakatta EG. Aging-associated cardiovascular changes and their relationship to heart failure. Heart Failure Clinics. 2012;8:143-64.
• 22. Oyetunji TA, Chang DC, Crompton JG, et al. Redefining hypotension in the elderly: normotension is not reassuring. Arch Surg. 2011;146:865–9.
• 23. Calland JF, Ingraham AM, Martin N, et al. Evaluation and management of geriatric trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Traum Acute Care. 2012;73:S345–50
• 24. Duschessne J, De La’O C: Prehospital Care. In: Rodriguez A, et al. (eds.) Geriatric Trauma and Acute Care Surgery. 1nd ed, Baltimor, Sringer,2018, p.29-37.
• 25. Gardner RC, Dams-O'Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. Journal of neurotrauma. 2018;35:889-906.
• 26. Harris C, DiRusso S, Sullivan T, Benzil DL. Mortality risk after head injury increases at 30 years. J Am Coll Surg. 2003;197:711–6.
• 27. TW Cutler, TR Clark. General Principles of Geriatric Drug Therapy. Journal of Contemporary Pharmacy Practice. 2018;65:31-6.
• 28. C Reske-Nielsen, R Medzon. Geriatric trauma. Emerg Med Clin North Am. 2016;34:483–500.
• 29. Bhandarkar P, Pal R, Munivenkatappa A, et al. Distribution of laboratory parameters in trauma population. Journal of emergencies, trauma, and shock. 2018;11:10.
• 30. Peñasco Y, Sánchez-Arguiano MJ, González-Castro A, et al. Whole-body computed tomography as a factor associated with lower mortality in severe geriatric trauma with thoracic-abdominal-pelvic injury. Revista Española de Anestesiología y Reanimación (English Edition), 2018;65:323-28.