|Year : 2017 | Volume
| Issue : 1 | Page : 33-35
Geriatric epidemiology of trauma in a hospital in Southern Colombia
Yolercy Vasquez1, José Daniel Charry2, Juan Daniel Ochoa3, Ana María Gómez3, Karen Herrera3, Jorman Harvey Tejada4, Jose Domingo Alarcón1
1 Department of Family Medicine, Faculty of Health Sciences; Grupo de Investigación Desarrollo Social, Salud Pùblica y Derechos Humanos, Surcolombiana University, Neiva, Colombia
2 Grupo de Investigación Desarrollo Social, Salud Pùblica y Derechos Humanos, Surcolombiana University; Department of Medicine, Faculty of Health Sciences, Fundación Universitaria Navarra-UNINAVARRA; Department of Medicine, Faculty of Health Sciences, Surcolombiana University, Neiva, Colombia
3 Grupo de Investigación Desarrollo Social, Salud Pùblica y Derechos Humanos; Department of Medicine, Faculty of Health Sciences, Surcolombiana University, Neiva, Colombia
4 Grupo de Investigación Desarrollo Social, Salud Pùblica y Derechos Humanos, Surcolombiana University; Neuroanesthesiologist Medical, Coordinator of Postgraduate Program in Anesthesiology and Reanimation, Faculty of Health Sciences-Surcolombiana University, Neiva, Colombia
|Date of Web Publication||15-Sep-2017|
José Daniel Charry
Department of Medicine, Faculty of Health Sciences. Fundación Universitaria Navarra-UNINAVARRA, Neiva
Source of Support: None, Conflict of Interest: None
Objective: To describe the clinical and sociodemographic characteristics of geriatric patients who were treated at a university hospital in southern Colombia.
Methods: A database of trauma patients over 65 admitted between June 2014 and December 2015 was constructed. Univariate analysis was performed. Measures of central tendency and dispersion for continuous variables were calculated.
Results: A total of 760 patients were analyzed, the median age was 74 years (65–98). The median injury severity score was 9 (4–25) the 71.97% were men, and overall mortality was 25.39%. The 92.10% was blunt trauma, and the main mechanism of injury was falls.
Conclusions: Trauma in the elderly is a common condition with high risk of mortality. It is important to know the frequency of these injuries to provide the best possible handling. In our hospital we found that geriatric trauma is a common disease, the main cause is falls without embargos traffic accidents are common in this population.
Keywords: Trauma, Geriatrics, Epidemiology
|How to cite this article:|
Vasquez Y, Charry JD, Ochoa JD, Gómez AM, Herrera K, Tejada JH, Alarcón JD. Geriatric epidemiology of trauma in a hospital in Southern Colombia. J Acute Dis 2017;6:33-5
|How to cite this URL:|
Vasquez Y, Charry JD, Ochoa JD, Gómez AM, Herrera K, Tejada JH, Alarcón JD. Geriatric epidemiology of trauma in a hospital in Southern Colombia. J Acute Dis [serial online] 2017 [cited 2021 Apr 13];6:33-5. Available from: http://www.jadweb.org/text.asp?2017/6/1/33/214611
| 1. Introduction|| |
The trauma is of global importance, causing around 5 million deaths a year, of which million are traffic accidents,. According to a study of the World Health Organization in global disease overload, published in 2010,, the trauma still is a public health problem and generates an important load for the health systems in Latin-American countries. In Colombia the global load of injuries, is more prominent in males economically active between ages of 12 to 45. But the trauma is a heterogeneous pathology and affects elderly people finding a high percentage of mortality and morbidity in these group of patients.
The trauma constitutes an important cause of incapacity and death in all ages, but it impacts differently in each group. It's responsible of 25% of death in the different group ages, but only 5.7% of departure on 65 years old patients. Although is estimated that death by trauma in elders is six times more than in younger population managed by injury degree. It has been proofed advanced age is a risk factor to negative outcomes in patients with trauma,,.
The physiological deterioration and chronic disease affecting old people are responsible of increase in morbidity and mortality related with trauma in this demographic group. The objective of this study was to describe the clinical and sociodemographic characteristics of geriatric patients attended in a university hospital in South Colombia.
| 2. Materials and Methods|| |
2.1. Design and patient population
Retrospective descriptive observational study of the patients older than 65 years old victims of traumatic injury attended in the Neiva University Hospital (NUH) between June 2014 and December 2015. Approval from the NUH quality improvement office and the institutional review boards of NUH was obtained prior to conducting this study. Were included in the study those patients with trauma older than 65 years admitted in the institution. NUH is a level 1 hospital that counts with 504 beds and an important trauma center of reference for the region. NUH admits approximately 2 000 adult trauma patients per year and has 30 adult intensive care unit beds. The hospital is the primary trauma center for 3.2 million inhabitants living in an area extending over 60 000 square miles. Its radius of care extends far into the Amazonian region, where the most intense fighting among rebel groups, cocaine traffickers and government forces has taken place for over 40 years.
2.2. Data collection and statistical analysis
The method used for data recollection was direct observational nonparticipating. The document review was made by data recording writing down the outcomes on data sheet with epidemiological data, clinical and social data. Confidentiality on the content of the records was kept by the investigators and information was only utilized for the research purpose. The results obtained in the study were stored and analysed in an online statistical software R version 2.15.2. Measures of central tendency and dispersion for continuous variables were calculated as well as frequencies and proportions for the categories.
| 3. Results|| |
A total of 760 patients were analyzed. The median age was 74 years (65–98). The median injury severity score was 9 (4–25). The 71.97% were men, and overall mortality was 25.39%. The clinical variables were shown in [Table 1].
|Table 1: Clinical and sociodemographic features of patients victims of trauma (n = 760).|
Click here to view
Patients who entered the institution, victims of trauma, the general mortality was of 25.39%, and the principal type of trauma was convincing. In the background identification, the 78.94% (600) were hypertensive, 42.89% (326) diabetics, 35.13% (267) smokers. Regarding the type of injury presented, falls were the most common cause in 68.15% followed by traffic accidents in 25.39%, hurt by sharp short weapon 5.26% and ballistic trauma at 1.18%. [Table 2] describes the diagnoses found regarding the anatomic location of the trauma. Vehicles related with the traffic accidents were seen in [Table 3]. The average length of hospital stay was [(16.60 ± 5.78) days].
|Table 2: Clinical findings of patients admitted to the institution (n = 760).|
Click here to view
|Table 3: Type of vehicle related with the notice of patients admitted to the institution (n = 193).|
Click here to view
| 4. Discussion|| |
Trauma is one of the pathologies that cause greater disability and mortality globally, generates about 5 million deaths per year and affects people between the ages of 14 to 45 years in which young people are more productive from the labour perspective. In our study we observed a population of over 65 are a common cause of admission to our hospital, with a median age of 74 years,,.
We must differentiate the elderly between 65 and 80 years from the advanced elderly, over 80 years, with mortality four times higher. A third of patients over 65 years old have preexisting conditions that contribute to double up the hospital stay in comparison with younger adults, but advanced age is a physiological alteration itself incapacitates the patient to respond to stress. This causes lesions in patients with moderate injury, so we should offer care corresponded to more severe injuries in younger people. The elderly are more susceptible to serious injury with less severe injuries than anyone younger, at the same time is less able to produce an adequate physiological response,,. The elders made less frequently risk activities than younger people to suffer trauma, but are more likely to suffer them in everyday activities such as falls at home. When driving motor vehicles have a higher number of accidents to be more frequent syncopal in this age group as well as by decreasing sensory faculties and reaction to an external stimulus,,,.
Confusion and loss of hearing and vision makes some elderly vulnerable even in their own homes,,,,. Even in the absence of cataracts and glaucoma, visual acuity, accommodation, peripheral vision and dark adaptation diminish with age. The balance is worse, therefore aging of the vestibular system as the usual side effects of their medications. There is almost always some degree of cervical osteoartosis. The decreased muscle mass and bone disorders degenerative worse coordination,. Orthostatic hypotension is common, but even more if they are involved in treatments with diuretics or benzodiazepines. Wet floors, stairs, carpets, etc. are not an architectural risk for young people, but for the elderly they are. This is important to keep in mind to avoid trauma,,,,. In our study we found that geriatric trauma is an important pathology, the main income associated with head injuries. It is important to identify these lesions and establish institutional management protocols to help decrease morbidity and hospital mortality.
The trauma in elderly people is a frequent pathology, with high risk of mortality. It is important to know the frequency of these injuries and handle it in the best way possible. In our hospital we found geriatric trauma is a frequent pathology, and the principal cause is falling, however traffic accidents are common in this population.
Conflict of interest statement
The authors report no conflict of interest.
| References|| |
Byass P, de Courten M, Graham WJ, Laflamme L, McCaw-Binns A, Sankoh OA, et al. Reflections on the global burden of disease 2010 estimates. PLoS Med
Horton R. GBD 2010: understanding disease, injury, and risk. Lancet
Norton R, Kobusingye O. Injuries. N Engl J Med
Chisholm D, Rehm J, Van Ommeren M, Monteiro M. Reducing the global burden of hazardous alcohol use: a comparative cost- effectiveness analysis. J Stud Alcohol
Zafar SN, Shah AA, Zogg CK, Hashmi ZG, Greene WR, Haut ER, et al. Morbidity or mortality? Variations in trauma centres in the rescue of older injured patients. Injury
Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Hashmi A, Green DJ, et al. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg
Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc
Briceno-Leon R, Villaveces A, Concha-Eastman A. Understanding the uneven distribution of the incidence of homicide in Latin America. Int J Epidemiol
Kharrazi RJ, Nash D, Mielenz TJ. Increasing trend of fatal falls in older adults in the United States, 1992 to 2005: coding practice or reporting quality? J Am Geriatr Soc
Rehm J, Room R, Monteiro M, Gmel G, Graham K, Rehn N, et al. Alcohol as a risk factor for global burden of disease. Eur Addict Res
Pridemore WA, Chamlin MB. A time-series analysis of the impact of heavy drinking on homicide and suicide mortality in Russia, 1956-2002. Addiction
Klimkiewicz A, Jakubczyk A, Wnorowska A, Klimkiewicz J, Bohnert A, Ilgen MA, et al. Violent behavior and driving under the influence of alcohol: prevalence and association with impulsivity among individuals in treatment for alcohol dependence in Poland. Eur Addict Res
Saar I. Do alcohol excise taxes affect traffic accidents? Evidence from Estonia. Traffic Inj Prev
2015; 16: 213-8.
Ju Y, Sohn SY. Time to death analysis of road traffic accidents in relation to delta V, drunk driving, and restraint systems. Traffic Inj Prev
Hsieh CH, Su LT, Wang YC, Fu CY, Lo HC, Lin CH. Does alcohol intoxication protect patients from severe injury and reduce hospital mortality? The association of alcohol consumption with the severity of injury and survival in trauma patients. Am Surg
Sánchez AI, Villaveces A, Krafty RT, Park T, Weiss HB, Fabio A, et al. Policies for alcohol restriction and their association with interpersonal violence: a time-series analysis of homicides in Cali, Colombia. Int J Epidemiol
Ferraris VA, Ferraris SP, Saha SP. The relationship between mortality and preexisting cardiac disease in 5,971 trauma patients. J Trauma
[Table 1], [Table 2], [Table 3]