Traumatological Aspect of Polytrauma Treatment for Elderly and Senile Patients
https://doi.org/10.23934/2223-9022-2021-10-3-530-539
Abstract
The conducted analysis of Russian and foreign literature sources showed that the problem of diagnostics and treatment of polytrauma in elderly and senile patients is still relevant. The main discussion point is the high mortality rate in this group of patients. Although at this level of the medicine’s evolution, an active approach to the treatment offered to such patients is applicable, the mortality rate in this group of patients remains much higher than in the group of patients under 65. The priority here is to study the difficulties of diagnosing injuries in elderly and senile patients with polytrauma. Also, a fundamental issue is the development of an effective algorithm for the surgical treatment of injuries, taking into consideration agerelated changes, the presence of concomitant pathology and an increased risk of complications in patients of this age group.
About the Authors
R. I. Valieva
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation
Russian Federation
Junior Researcher, Department of Combined and Multiple Trauma
3 Bolshaya Sukharevskaya Square, Moscow 129090, Russian Federation
P. A. Ivanov
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation
Russian Federation
Doctor of Medical Sciences, Head of the Scientific Department of Combined and Multiple Trauma
3 Bolshaya Sukharevskaya Square, Moscow 129090, Russian Federation
References
1. World Population Prospects: The 2012 Revision. Volume II: Demographic Profiles. New York, NY; 2013. Available at: https://population.un.org/wpp/Publications/Files/WPP2012_HIGHLIGHTS.pdf [Accessed Oct 9, 2020]
2. Obshchaya chislennost’ pensionerov v Rossiyskoy Federatsii. Available at: https://gks.ru/folder/13877 [Accessed October 6, 2020] (In Russ.).
3. Chislennost’ naseleniya po otdel’nym vozrastnym gruppam. Available at: https://www.gks.ru/folder/12781 [Accessed Oct 6, 2020] (In Russ.).
4. Beard JR, Officer AM, Cassels AK. The world report on ageing and health. Gerontologist. 2016;56(Suppl 2):S163–S166. PMID: 26994257 https://doi.org/10.1093/geront/gnw037
5. Chislennost’ rabotayushchikh pensionerov, sostoyashchikh na uchete v sisteme pensionnogo fonda Rossiyskoy Federatsii, po vidam pensionnogo obespecheniya i kategoriyam pensionerov v Rossiyskoy Federatsii. Available at: https://gks.ru/folder/13877 [Accessed October 6, 2020] (In Russ.).
6. Kocuvan S, Brilej D, Stropnik D, Lefering R, Komadina R. Evaluation of major trauma in elderly patients – a single trauma center analysis. Wiener Klin Wochenschrift. 2016;128(Suppl 7):535–542. PMID: 27896468 https://doi.org/10.1007/s00508-016-1140-4
7. Richmond TS, Kauder D, Strumpf N, Meredith T. Characteristics and outcomes of serious traumatic injury in older adults. J Am Geriat Soc. 2002;50(2):215–222. PMID: 12028201 https://doi.org/10.1046/j.1532-5415.2002.50051.x
8. Van den Akker M, Buntix F, Metsemakers JF, Roos S, Knottnerus JA. Multimorbidity in general practice: Prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol. 1998;51(5):367–375. PMID: 9619963 https://doi.org/10.1016/S0895-4356(97)00306-5
9. Labeznik LB, Konev YuV, Drozdov VN, Efremov LI. Polipragmaziya: geriatricheskiy aspekt problemy. Consilium Medicum. 2007;9(12):29–34. (In Russ.).
10. Blazhenko AA, Sabodashevskiy OV, Mukhanov ML, Konovalov EV, Konovalov YuV, Solodkiy DA, et al. Polytrama features in patients older than 60 years. Innovacionnaâ medicina Kubani. 2016;(1):38–42. (In Russ.).
11. Dvoretskiy LI. Pozhiloy bol’noy v praktike terapevta. Russian Medical Journal. 1997;5(20):58–59. (In Russ.).
12. Cummings SR, Melton, LJ. Osteoporosis I: Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761–1767. PMID: 12049882 https://doi.org/10.1016/S0140-6736(02)08657-9
13. Mel’nichenko GA, Belaya ZhE, Rozhinskaya LYa, Toroptsova NV, Alekseeva LI, Biryukova EV, et al. Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis. Problems of Endocrinology. 2017;63(6):392–426. (in Russ.). https://doi: 10.14341/probl2017636392-426
14. Pioli G, Bendini C, Pignedoli P, Giusti A, Marsh D. Orthogeriatric co-management – managing frailty as well as fragility. Injury. 2018;49(8):1398–1402. PMID: 29921533 https://doi:10.1016/j.injury.2018.04.014
15. Bone health and osteoporosis. A report of the Surgeon General. US Health and Human Services; 2004. PMID: 20945569
16. Van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001;29(6):517–522. PMID: 11728921 https://doi.org/10.1016/S8756-3282(01)00614-7
17. Susman M, DiRusso SM, Sullivan T, Risucci D, Nealon P, Cuff S, et al. Traumatic brain injury in the elderly: Increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma. 2002;53(2):219–224. PMID: 12169925 https://doi.org/10.1097/00005373-200208000-00004
18. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib Fractures in the Elderly. J Trauma. 2000;48(6):1040–1047. PMID: 10866248 https://doi:10.1097/00005373-200006000-00007
19. Giannoudis PV, Harwood PJ, Court-Brown C, Pape HC. Severe and multiple trauma in older patients; incidence and mortality. Injury. 2009;40(4):362–367. PMID: 19217104 https://doi.org/10.1016/j.injury.2008.10.016
20. de Vries R, Reininga IHF, Pieske O, Lefering R, Moumni M, Wendt K. Injury mechanisms, patterns and outcomes of older polytrauma patients—an analysis of the Dutch trauma registry. PLoS ONE. 2018;13(1):e0190587. PMID: 29304054 https://doi.org/10.1371/journal.pone.0190587
21. Lee HS, Kim MJ. A study on fall accident. Taehan Kanho. The Korean Nurse. 1997;36(5):45–62. PMID: 10437605
22. Atwell SE. Trauma in the elderly. In: McQuillian K, Von Rueden K, Hartsock R, Flynn M, Whalen E (eds.) Trauma Nursing: From Resuscitation Through Rehabilitation. Philadelphia, PA: WB Saunders; 2002. p.772-787.
23. Demetriades D, Murray J, Brown C, Velmahos G, Salim A, Alo K, Rhee P. High-level falls: Type and severity of injuries and survival outcome according to age. J Trauma. 2005;58(2):342–345. PMID: 15706198 https://doi:10.1097/01.ta.0000135161.44100.d8
24. Zhou B, Bentham J, Di Cesare M, Bixby H, Danaei G, Cowan MJ, et al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet. 2017;389(10064):37–55. PMID: 27863813 https://doi:10.1016/s0140-6736(16)31919-5
25. Chow CK, Teo K, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, Awareness, Treatment, and Control of Hypertension in Rural and Urban Communities in High-, Middle-, and Low-Income Countries. JAMA. 2013;310(9):959–968. PMID: 24002282 https://doi:10.1001/jama.2013.184182
26. Braun BJ, Holstein J, Fritz T, Veith NT, Herath S, Mörsdorf P, et al. Polytrauma in the elderly: a review. EFORT Open Rev. 2016;1(5):146–151. PMID: 20585241 https://doi.org/10.1302/2058-5241.1.160002
27. Held FP, Blyth F, Gnjidic D, Hirani V, Naganathan V, Waite LM, et al. Association Rules Analysis of Comorbidity and Multimorbidity: The Concord Health and Aging in Men Project. J Gerontol Ser A: Biol Sci Med Sci. 2015;71(5):625–631. PMID: 26508296 https://doi:10.1093/gerona/glv181
28. Tebby J, Lecky F, Edwards A, Jenks T, Bouamra O, Dimitriou R, et al. Outcomes of polytrauma patients with diabetes mellitus. BMC Medicine. 2014;12(1):111. PMID: 25026864 https://doi:10.1186/1741-7015-12-111
29. Aderinto J, Keating JF. Intramedullary nailing of fractures of the tibia in diabetics. J Bone Joint Surg. 2008;90-B(5):638–642. PMID: 18450632 https://doi.org/10.1302/0301-620X.90B5.19854
30. Lynde MJ, Sautter T, Hamilton GA, Schuberth JM. Complications after open reduction and internal fixation of ankle fractures in the elderly. Foot Ankle Surg. 2012;18(2):103–107. PMID: 22443995 https://doi:10.1016/j.fas.2011.03.0102012
31. Obesity and overweight. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [Accessed Oct 6, 2020]
32. Neville AL, Brown CVR, Weng J, Demetriades D, Velmahos GC. Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg. 2004;139(9):983–987. PMID: 15381617 https://doi.org/10.1001/archsurg.139.9.983
33. Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: A study of over 600 000 elderly patients from the Swedish prescribed drug register. Drug Safety. 2007;30(10):911–918. PMID: 17867728 https://doi.org/10.2165/00002018-200730100-00009
34. Charlesworth CJ, Smit E, Lee DSH, Alramadhan F, Odden MC. Polypharmacy among adults aged 65 years and older in the United States: 1988–2010. J Gerontol: Ser A. 2015;70(8):989–995. PMID: 25733718 https://doi.org/10.1093/gerona/glv013
35. Beijer HJM, De Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): A metaanalysis of observational studies. Pharm World Sci. 2002;24(2):46–54. PMID: 12061133 https://doi.org/10.1023/A:1015570104121
36. de Vries R, Reininga IHF, de Graaf MW, Heineman E, El Moumni M, Wendt KW. Older polytrauma: Mortality and complications. Injury. 2019;50(8):1440–1447. PMID: 31285055 https://doi:10.1016/j.injury.2019.06.024
37. Oreskovich MR, Howard JD, Copass MK, Carrico C. Geriatric trauma: Injury patterns and outcome. J Trauma. 1984;24(7):565–572. PMID: 6748116 https://doi.org/10.1097/00005373-198407000-00003
38. Sokolov VA. Obshchie voprosy politravm. In: Sokolov VA. (ed.) Mnozhestvennye i sochetannye travmy. Moscow: GEOTAR-media Publ.; 2006. Pt.1. p.10. (in Russ.).
39. Huber-Wagner S, Lefering R, Qvick LM, Körner M, Kay MV, Pfeifer KJ, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373(9673):1455–1461. PMID: 19321199 https://doi.org/10.1016/S0140-6736(09)60232-4
40. Pfeifer R, Tarkin IS, Rocos B, Pape HC. Patterns of mortality and causes of death in polytrauma patients-Has anything changed? Injury. 2009;40(9):907–911. PMID: 19540488 https://doi.org/10.1016/j.injury.2009.05.006
41. Ciriello V, Gudipati S, Stavrou PZ, Kanakaris NK, Bellamy MC, Giannoudis PV. Biomarkers predicting sepsis in polytrauma patients: Current evidence. Injury. 2013;44(12):1680–1692. PMID: 24119650 https://doi.org/10.1016/j.injury.2013.09.024
42. Wolff G, Langenstein H. Akute herzinsuffizienz nicht primar kardialer genese nach polytrauma. Schweiz Med Wochensch. 1981;111(47):1795–1798. PMID: 7313649
43. Goris R JA, Gimbrère JSF, Van Niekerk JLM, Schoots FJ, Booy LHD. Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma. 1982;22(11):895–903. PMID: 6754962 https://doi.org/10.1097/00005373-198211000-00002
44. Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Ser A. 1989;71(3):336–340. PMID:2925704 https://doi.org/10.2106/00004623-198971030-00004
45. Behrman SW, Fabian TC, Kudsk KA, Taylor JC. Improved outcome with femur fractures: Early vs. delayed fixation. J Trauma. 1990;30(7):792–798. PMID: 2380996 https://doi.org/10.1097/00005373-199007000-00005
46. Charash WE, Fabian TC, Croce MA. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma. J Trauma. 1994;37(4):667–672. PMID: 7932901 https://doi.org/10.1097/00005373-199410000-00023
47. Fakhry SM, Rutledge R, Dahners LE, Kessler D. Incidence, management, and outcome of femoral shaft fracture: A statewide populationbased analysis of 2805 adult patients in a rural state. J Trauma. 1994;37(2):255–261. PMID: 8064926 https://doi.org/10.1097/00005373-199408000-00018
48. Reynolds MA, Richardson JD, Spain DA, Seligson D, Wilson MA, Miller FB. Is the timing of fracture fixation important for the patient with multiple trauma? Ann Surg. 1995;222(4):470–481. PMID: 7574927 https://doi.org/10.1097/00000658-199522240-00005
49. Giannoudis PV, Giannoudi M, Stavlas P. Damage control orthopaedics: lessons learned. Injury. 2009;40(Suppl4):S47–52. PMID: 19895952 https://doi.org/10.1016/j.injury.2009.10.036
50. Giannoudis PV. Surgical priorities in damage control in polytrauma. J Bone Joint Surg Ser B. 2003;85(4):478–483. PMID: 12793548 https://doi.org/10.1302/0301-620X.85B4.14217
51. Newell MA, Schlitzkus LL, Waibel BH, White MA, Schenarts PJ, Rotondo MF. «Damage control» in the elderly: Futile endeavor or fruitful enterprise? J Trauma. 2010;69(5):1049–1053. PMID: 21068610 https://doi.org/10.1097/TA.0b013e3181ed4e7a
52. Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Ser A. 1995;77(10):1551–1556. PMID: 7593064 https://doi.org/10.2106/00004623-199510000-00010
53. Sexson SB, Lehner JT. Factors affecting hip fracture mortality. J Orthop Trauma. 1987;1:298-305. PMID: 3506066 https://doi.org/10.1097/00005131-198701040-00005
54. Fröhlich M, Lefering R, Probst C, Paffrath T, Schneider MM, Maegele M, et al. Epidemiology and risk factors of multiple-organ failure after multiple trauma. J Trauma Acute Care Sur. 2014;76(4):921–928. PMID: 24662853 https://doi:10.1097/ta.0000000000000199
55. Blazhenko AN, Dubrov VE, Mukhanov ML, Lysykh EG, Zobenko VYa, Blazhenko AA. The interrelation of changes in laboratory parameters of homeostasis and mortality in elder age groups patients with polytrauma and the dominant injuries of the musculoskeletal system. Kuban Scientific Medical Bulletin. 2015;3(152):7–13. (In Russ.).
56. Vertkin AL, Naumov AV, Shakirova SR, Zaychenko DM. Osteoporosis in a physicians practice. Modern Rheumatology Journal. 2011;5(2):64–71. (in Russ.). https://doi.org/10.14412/1996-7012-2011-672
57. Miranda MA. Locking plate technology and its role in osteoporotic fractures. Injurу. 2007;38(3):35–39. PMID: 17723790 https://doi:10.1016/j.injury.2007.08.009
58. Switzer JA, Gammon SR. High-energy skeletal trauma in the elderly. J Bone Joint Surg Am. 2012;94(23):2195–2204. PMID: 23224390 https://doi:10.2106/JBJS.K.01166
59. Carulli C, Piacentini F, Paoli T, Civinini R, Innocenti M. A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw. Clin Cases Miner Bone Metab. 2017;14(1):40–47. PMID: 28740524 https://doi:10.11138/ccmbm/2017.14.1.040
60. Buyukdogan K, Caglar O, Isik S, Tokgozoglu M, Atilla B. Risk factors for cut-out of double lag screw fixation in proximal femoral fractures. Injury. 2017 48(2):414–418. PMID: 27889112 https://doi:10.1016/j.injury.2016.11.018
61. Kammerlander C, Gebhard F, Meier C, Lenich A, Linhart W, Clasbrummel B, et al. Standardised cement augmentation of the PFNA using a perforated blade: A new technique and preliminary clinical results. A prospective multicentre trial. Injury. 2011;42(12):1484–1490. PMID: 21855063 https://doi.org/10.1016/j.injury.2011.07.010
62. Wähnert D, Stolarczyk Y, Hoffmeier KL, Raschke MJ, Hofmann GO, Mückley T. The primary stability of angle-stable versus conventional locked intramedullary nails. Int Orthop. 2012;36(5):1059–1064. PMID: 22127384 https://doi:10.1007/s00264-011-1420-6
63. Wähnert D, Stolarczyk Y, Hoffmeier KL, Raschke MJ, Hofmann GO, Mückley T. Long-term stability of angle-stable versus conventional locked intramedullary nails in distal tibia fractures. BMC Musculoskelet Disord. 2013;14:66. PMID: 23425016 https://doi: 10.1186/1471-2474-14-66
64. Grossman MD, Miller D, Scaff DW, Arcona S. When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma. J Trauma. 2002;52(2):242–246. PMID: 11834982 https://doi.org/10.1097/00005373-200202000-00007
65. Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54(3):478–485. PMID: 12634526 https://doi.org/10.1097/01.TA.0000037095.83469.4C
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Valieva R.I., Ivanov P.A. Traumatological Aspect of Polytrauma Treatment for Elderly and Senile Patients. Russian Sklifosovsky Journal "Emergency Medical Care". 2021;10(3):530-539. https://doi.org/10.23934/2223-9022-2021-10-3-530-539
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