2.50
Hdl Handle:
http://hdl.handle.net/10755/162838
Type:
Presentation
Title:
Major Trauma in Older Persons - Often Difficult to Recognize
Abstract:
Major Trauma in Older Persons - Often Difficult to Recognize
Conference Sponsor:Emergency Nurses Association
Conference Year:2004
Author:Scheetz, Linda J., EdD, APRN, BC, CEN
P.I. Institution Name:Rutgers, The State University of New Jersey
Title:Assistant Professor
Contact Address:College of Nursing, 180 University Avenue, Newark, NJ, 07102, USA
Contact Telephone:(973) 353-5326
Purpose: Trauma mortality rates in older persons are higher than in younger persons with comparable
injuries. Accurate triage of older trauma patients is difficult, often resulting in undertriage to nontrauma
center hospitals (NTCs). The purpose of this study was to describe trauma center (TC) and NTC admissions
of MVC patients with major and minor trauma relative to the appropriate level of care.
Design/Setting: A retrospective statewide study was conducted in New Jersey, a state that had 9 TCs and
111 NTCs in 2000.
Sample: A sample of records of adults with MVC trauma was drawn from NJ's UB-92 Patient Discharge
Database for the year 2000. Inclusion criteria were age > 25 years, E-codes 810 - 819, ICD-9-CM codes 800 - 959, (excluding 905 - 909). The IRB for the protection of human subjects approved the study and waived
the informed consent requirement.
Methodology: In the Trauma Physiologic Response and Outcomes Model, patient age, injury severity,
injury type, and comorbidities influence the physiologic response to trauma. Physiologic response at the
injury scene influences the level of care (TC vs. NTC) to which the individual is admitted. Level of care,
complications, post-trauma stress, and post-injury depression influence trauma outcomes. Age, gender, hospital
ID, and ICD-9-CM codes were recorded. ICDMAP-90? translated ICD-9-CM codes into Injury Severity
Scores (ISS). An ISS score > 16 denoted major trauma. Proportions of subjects with major and minor trauma,
admitted to TCs and NTCs, were compared for four subgroups: Males age 25 to 64 years, males age >
65 years, females age 25 to 64 years, and females age > 65 years. Using Fisher's exact test, probability values
for variables of interest were calculated (alpha = .05).
Results: The final sample included records of 5,712 MVC patients, ages 25 to 99 years. ISS means were:
Younger males = 7.54, older males = 8.15, younger females = 7.06, older females = 7.03.Among patients
with ISS > 16,TC admissions were greatest for younger males (82 %, n = 467) and least for older females
(60%, n = 43) and older males (60%, n = 54). Regardless of injury severity, TC admissions were greater for
younger patients versus older patients (p < .0001), males versus females (p = .0069), and younger males
versus younger females (p = .0112).
Conclusions: Many older patients with major trauma were admitted to NTCs, possibly an inappropriate
level of care given their injury severity. Physiologic response may have been blunted so that major trauma
was not apparent to emergency personnel. Nurses working in NTCs should be alert to the possibility that
patients with major trauma may be brought to their emergency department. The findings of this study
underscore the need for future research that examines prehospital triage indicators and admission to the
appropriate level of care. [Poster Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleMajor Trauma in Older Persons - Often Difficult to Recognizeen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162838-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Major Trauma in Older Persons - Often Difficult to Recognize</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Scheetz, Linda J., EdD, APRN, BC, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Rutgers, The State University of New Jersey</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">College of Nursing, 180 University Avenue, Newark, NJ, 07102, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(973) 353-5326</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">lscheetz@andromeda.rutgers.edu</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Trauma mortality rates in older persons are higher than in younger persons with comparable<br/>injuries. Accurate triage of older trauma patients is difficult, often resulting in undertriage to nontrauma<br/>center hospitals (NTCs). The purpose of this study was to describe trauma center (TC) and NTC admissions<br/>of MVC patients with major and minor trauma relative to the appropriate level of care.<br/>Design/Setting: A retrospective statewide study was conducted in New Jersey, a state that had 9 TCs and<br/>111 NTCs in 2000.<br/>Sample: A sample of records of adults with MVC trauma was drawn from NJ's UB-92 Patient Discharge<br/>Database for the year 2000. Inclusion criteria were age &gt; 25 years, E-codes 810 - 819, ICD-9-CM codes 800 - 959, (excluding 905 - 909). The IRB for the protection of human subjects approved the study and waived<br/>the informed consent requirement.<br/>Methodology: In the Trauma Physiologic Response and Outcomes Model, patient age, injury severity,<br/>injury type, and comorbidities influence the physiologic response to trauma. Physiologic response at the<br/>injury scene influences the level of care (TC vs. NTC) to which the individual is admitted. Level of care,<br/>complications, post-trauma stress, and post-injury depression influence trauma outcomes. Age, gender, hospital<br/>ID, and ICD-9-CM codes were recorded. ICDMAP-90? translated ICD-9-CM codes into Injury Severity<br/>Scores (ISS). An ISS score &gt; 16 denoted major trauma. Proportions of subjects with major and minor trauma,<br/>admitted to TCs and NTCs, were compared for four subgroups: Males age 25 to 64 years, males age &gt;<br/>65 years, females age 25 to 64 years, and females age &gt; 65 years. Using Fisher's exact test, probability values<br/>for variables of interest were calculated (alpha = .05).<br/>Results: The final sample included records of 5,712 MVC patients, ages 25 to 99 years. ISS means were:<br/>Younger males = 7.54, older males = 8.15, younger females = 7.06, older females = 7.03.Among patients<br/>with ISS &gt; 16,TC admissions were greatest for younger males (82 %, n = 467) and least for older females<br/>(60%, n = 43) and older males (60%, n = 54). Regardless of injury severity, TC admissions were greater for<br/>younger patients versus older patients (p &lt; .0001), males versus females (p = .0069), and younger males<br/>versus younger females (p = .0112).<br/>Conclusions: Many older patients with major trauma were admitted to NTCs, possibly an inappropriate<br/>level of care given their injury severity. Physiologic response may have been blunted so that major trauma<br/>was not apparent to emergency personnel. Nurses working in NTCs should be alert to the possibility that<br/>patients with major trauma may be brought to their emergency department. The findings of this study<br/>underscore the need for future research that examines prehospital triage indicators and admission to the<br/>appropriate level of care. [Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:35:01Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:35:01Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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