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      Epidemiologia das lesões traumáticas de alta energia em idosos Translated title: Epidemiology of high-energy trauma injuries among the elderly

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          Abstract

          O aumento proporcional de idosos na população mundial associado à melhoria nas condições de saúde e suporte preventivo para essa faixa etária, permite forma de vida mais ativa, expondo-os a risco mais elevado de acidentes e traumas de alta energia. Esses pacientes têm características fisiológicas, doenças associadas, padrão comportamental e complicações pós-operatórias que levam a resposta sistêmica diferente dos demais grupos etários. Esse trabalho avaliou prospectivamente 28 pacientes com idade superior a 65 anos - 16 mulheres e 12 homens. O mecanismo de trauma mais prevalente foi atropelamento, resultando principalmente, em fraturas dos membros inferiores. O tempo de internação foi superior ao de pacientes de faixas etárias inferiores e 90% dos casos apresentaram algum tipo de complicação clínica após a osteossíntese. A idade age isoladamente como fator preditivo positivo para tais complicações no paciente politraumatizado. As doenças prévias e a idade dos doentes não influenciaram o desenvolvimento de complicações ortopédicas. As lesões associadas às fraturas apresentaram correlação com o mecanismo de trauma. Estes pacientes normalmente precisam ser operados para tratamento definitivo de suas fraturas. O fato de serem mais idosos e apresentarem doenças anteriormente ao acidente não aumenta o período pré-cirúrgico.

          Translated abstract

          The increasing proportion of elderly people in the world's population, together with improvements in their health status and the preventive support for this age group, have allowed them to have more active lifestyles, which have exposed them to higher risks of high-energy accidents and trauma. These patients have physiological characteristics, associated diseases, behavioral patterns and postoperative complications that lead to different systemic responses from those on other age groups. This study prospectively evaluated 28 patients aged over 65 years - 16 women and 12 men. The most prevalent trauma mechanism was trampling, which mainly resulted in leg fractures. The period of hospitalization for these patients was greater than in younger age groups, and 90% of the cases presented some type of clinical complication following osteosynthesis. Age alone acted as a positive predictive factor for such complications among patients with multiple traumas. Previous diseases and patients' ages did not have any influence on the development of orthopaedic complications. The injuries associated with the fractures presented a correlation with the trauma mechanism. These patients usually require surgery for definitive treatment of their fractures. Being older and presenting diseases prior to the accident did not increase the length of time before surgery.

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          Pre-existing disease in trauma patients: a predictor of fate independent of age and injury severity score.

          Improvement in trauma management requires a better understanding of the effect of a patient's preinjury health status on outcome. Specific historical findings and laboratory criteria were used to define pre-existing disease (PED) states and determine if they were independent predictors of fate in trauma victims. Of 7,798 adult patients admitted to a level I trauma center from July 1986 through June 1990, 16.0% (1,246) had greater than or equal to 1 PED. The PED+ and PED- patients had no significant difference in Injury Severity Scores (ISSs) (15.7 versus 15.6) and admission Glasgow Coma Scale (GCS) scores (13.9 versus 13.8). The PED+ patients were older (49.2 versus 30.6 years) (p less than 0.001) and had a higher mortality rate (9.2% versus 3.2%) (p less than 0.001) than PED- patients. Mortality rates were also elevated for patients with greater than or equal to 2 PEDs (18%) and for those with renal disease (38%), malignancy (20%), and cardiac disease (18%) (p less than 0.001) compared with PED- patients. Controlling for age and ISS, there was an association between PED and mortality (Mantel-Haenszel p less than 0.03). Multivariate regression showed that PED is an independent predictor of mortality (R2 = 0.1918; p less than 0.0001). The greatest increases in mortality were found among patients less than 55 years and with ISS less than 20. Changes in prehospital triage criteria and outcome scoring are needed. Improvements in the management of trauma victims with chronic disease may decrease their mortality rate.
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            Special considerations in geriatric injury.

            As the elderly population expands and adopts increasingly more active lifestyles, trauma and critical care practitioners will be faced with providing care for greater numbers of severely injured patients. However, because of their associated preexisting medical conditions and poor relative physiologic reserve, geriatric patients have higher mortality rates and poorer long-term functional outcomes than their younger counterparts. A thorough understanding of the causes for these disparate outcomes is critical if successful strategies and treatments for this unique patient population are to be developed. The currently available geriatric trauma literature is largely descriptive and retrospective, and does not provide ready explanations or solutions for the substantially worse outcomes experienced by this patient population. It does appear that outcomes are improved by providing early and aggressive care in designated trauma centers, yet undertriage remains a significant problem. Early admission to an ICU has been recommended, but its benefits remain unproved. Significant differences exist between older and younger patients in injury patterns, and in the frequency and type of complications These differences in turn demand prompt diagnostic approaches, aggressive treatment, and unique prevention strategies. Ironically, the field of geriatric trauma is still in its infancy. Given the relation between advanced age, associated preexisting medical conditions, and poor physiologic reserve, a poor outcome may be inevitable by the time the geriatric patient presents for medical attention. Greater emphasis should therefore be placed on injury prevention efforts in this patient population. There is a dire need for well-designed prospective studies in geriatric trauma.
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              Trauma no idoso

              O crescimento populacional de idosos, associado a uma forma de vida mais saudável e mais ativa, deixa este grupo de pessoas mais exposto ao risco de acidentes. Em alguns países, o trauma do idoso responde por uma elevada taxa de mortalidade, a qual se apresenta de forma desproporcionalmente maior do que a observada entre a população de adultos jovens. Tal fato acarreta um grande consumo de recursos financeiros destinados à assistência da saúde e um elevado custo social. As características fisiológicas próprias do idoso, assim como a presença freqüente de doenças associadas, faz com que estes pacientes se comportem diferentemente e de forma mais complexa do que os demais grupos etários. Estas particularidades fazem com que o atendimento ao idoso vítima de trauma se faça de forma diferenciada. A presente revisão aborda aspectos da epidemiologia, da prevenção, da fisiologia, do atendimento e da reabilitação do idoso vítima de trauma.
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                Author and article information

                Journal
                aob
                Acta Ortopédica Brasileira
                Acta ortop. bras.
                ATHA EDITORA (São Paulo, SP, Brazil )
                1413-7852
                1809-4406
                2008
                : 16
                : 5
                : 279-283
                Affiliations
                [01] orgnameUSP orgdiv1FM orgdiv2HC
                Article
                S1413-78522008000500005 S1413-7852(08)01600505
                62d340f5-8c08-403e-b3ff-d4491e82795c

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 16 August 2007
                : 26 October 2007
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 5
                Product

                SciELO Brazil

                Categories
                Artigo Original

                Idosos,Ferimentos e lesões,Elderly,Epidemiologia,Wounds and injuries,Epidemiology

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