Comparative analysis of the characteristics of traumas suffered by elderly and younger patients.

OBJECTIVE: To assess the characteristics of traumas suffered by the elderly by comparison with a group of younger trauma victims. METHODS: Trauma protocols from June 10, 2008 to March 9, 2009 were evaluated including all trauma patients above 13 years of age admitted to the emergency room. Data were collected on trauma mechanism, preexisting diseases, vital signs on admission, injuries diagnosed, trauma index scores, tests and treatment. Patients over 60 years were assigned to the elderly group (Group I). Data were compared between this group and a group of younger patients (Group II), using Student's t test, the chi square test and Fisher's exact test, considering p<0.05 as significant. RESULTS: Two thousand and seventy-five trauma victims were recruited (77.1% male), 211 (10.2%) in group I. The most frequent trauma mechanisms in the elderly were falls (from patients' own height) (41%) and being hit by automobiles (28%). Preexisting diseases were more frequent in Group I and included systemic arterial hypertension and diabetes mellitus. The most frequent injuries to Group I patients were to the extremities, affecting 106 patients (50.2%). Fractures were diagnosed in 18% of the elderly patients. In comparison with younger trauma patients, elderly patients had significantly higher head scores on the AIS (0.75 + 1.17 vs. 0.54 + 1.04) (p=0.014) and lower thoracic (0.15 + 0.62 vs. 0.26 + 0.86) (p=0.018) and abdominal scores (0.05 + 0.43 vs. 0.21 + 0.82) (p<0.001). Severe injuries (AIS > 3) to the head were more frequently observed in Group I (11.4% vs. 7%) (p=0,023). Certain types of injury were more frequent in Group I: subdural hematomas (2.8% vs. 0.8%) (p=0.008), subarachnoid hemorrhages (3.8% vs. 1.3%) (p=0.005) and cerebral contusions (5.2% vs. 2.3%) (p=0.015). CONCLUSION: In comparison to younger trauma victims, the elderly group was characterized by a higher frequency of falls from their own height, concomitant diseases and severe intracranial injuries, including subdural hematoma, cerebral contusions and subarachnoid hemorrhages.

Análise comparativa das características do trauma entre pacientes idosos e não idosos / Comparative analysis of trauma characteristics between elderly and younger trauma patients

OBJETIVO: Definir as características do trauma em idosos pela comparação de variáveis entre este grupo e o de traumatizados não idosos. MÉTODOS: Realizamos uma análise dos protocolos coletados no período de 10 de junho de 2008 a 9 de março de 2009, incluindo todos os traumatizados atendidos com idade superior a 13 anos. Foram coletados dados de identificação, mecanismo de trauma, informações do pré-hospitalar, dados vitais à admissão, índices de trauma, exames complementares, doenças associadas, lesões diagnosticadas e tratamento. Os traumatizados com idade superior a 60 anos foram considerados idosos. Para a identificação das características do trauma em idosos, comparamos as variáveis entre este grupo (Grupo I) e os traumatizados não idosos (Grupo II). Foram empregados os testes T de Student, Qui quadrado e Fisher para a comparação entre os grupos, considerando o valor de p<0,05 como significativo. RESULTADOS: Foram incluídos no estudo 2075 vítimas de trauma, sendo 77,1 por cento do sexo masculino. Duzentos e onze doentes (10,2 por cento) tinham idade superior a 60 anos (Grupo I). Os idosos foram mais frequentemente vítimas de queda da própria altura (41 por cento) e atropelamento (28,6 por cento), enquanto, no Grupo II, predominaram os acidentes com motocicletas (28 por cento) (p<0,001). Os idosos apresentaram maior frequência de doenças associadas, sendo as principais a hipertensão arterial sistêmica (13,7 por cento vs. 1,1 por cento) e o diabetes mellitus (4,7 por cento vs. 0,3 por cento). As lesões em extremidades foram encontradas em 106 doentes do Grupo I (50,2 por cento), sendo fraturas em 38 casos (18 por cento). Em comparação com os demais traumatizados, os idosos se caracterizaram por apresentar maior média de AIS no segmento cefálico (0,75 + 1,17 vs. 0,54 + 1,04) (p=0,014) e menor média de AIS no tórax (0,15 + 0,62 vs. 0,26 + 0,86) (p=0,018) e no abdome (0,05 + 0,43 vs. 0,21 + 0,82) (p<0,001). No Grupo I, notou-se também maior frequência de lesões graves (AIS > 3) no segmento cefálico (11,4 por cento vs. 7 por cento) (p=0,023) e menor frequência de lesões graves no abdome (1,4 por cento vs. 4,3 por cento) (p=0,025). Algumas lesões foram significativamente mais frequentes nos idosos, como os hematomas subdurais (2,8 por cento vs. 0,8 por cento) (p=0,008), as hemorragias subaracnóideas (3,8 por cento vs. 1,3 por cento) (p=0,005) e as contusões cerebrais (5,2 por cento vs. 2,3 por cento) (p=0,015) quando comparados aos demais traumatizados. CONCLUSÃO: Em comparação aos traumatizados não idosos, os idosos apresentaram as seguintes características: maior frequência de quedas da própria altura, de doenças associadas e de lesões graves intracranianas, incluindo os hematomas subdurais, as contusões cerebrais e as hemorragias em espaço subaracnoide.

OBJECTIVE: Assess the characteristics of trauma in the elderly by comparison to a group of younger trauma patients. METHODS: Trauma protocols from June 10, 2008 to March 9, 2009 were evaluated including all trauma patients above 13 years of age admitted in the emergency room. Data on trauma mechanism, concomitant diseases, vital signs upon admission, diagnosed injuries, trauma indexes, exams and treatment was collected. Patients above 60 years of age. were included in the elderly group (group I). Data was compared between this group and the younger patients (group II), using the Student's t, chi square and Fisher exact tests, considering p<0.05 as significant. RESULTS: Two thousand and seventy five victims of trauma were included (77.1 percent male), 211 (10.2 percent) in group I. The most frequent trauma mechanisms in the elderly were falls (from their own height) (41 percent) and pedestrian struck (28 percent). Concomitant diseases were more frequent in group I, including systemic arterial hypertension and diabetes mellitus. In group I, the most frequent lesions were located at extremities in 106 patients (50.2 percent). Fractures were present in 18 percent of the elderly. In comparison to younger trauma patients, the elderly had significantly higher head AIS (0.75 + 1.17 vs 0.54 + 1.04) (p=0.014) and lower thoracic (0.15 + 0.62 vs 0.26 + 0.86) (p=0.018) and abdominal (0.05 + 0.43 vs 0.21 + 0.82) (p<0.001) AIS. Severe injuries (AIS > 3) in the head were more frequently observed in group I (11.4 percent vs 7 percent) (p=0,023). Some injuries were more frequent in group I: subdural hematomas (2.8 percent vs 0.8 percent) (p=0.008), subarachnoid hemorrhage (3.8 percent vs 1.3 percent) (p=0.005) and cerebral contusions (5.2 percent vs 2.3 percent) (p=0.015). CONCLUSION: In comparison to younger trauma patients, the elderly group was characterized by a higher frequency of falls from their own height, , concomitant diseases and severe injuries in the head, mainly subdural hematomas, cerebral contusions and subarachnoid hemorrhage.