Geriatric injury: An analysis of prehospital demographics, mechanisms, and patterns

doi:10.1016/S0196-0644(05)82611-3

Annals of Emergency Medicine

Volume 19, Issue 12, December 1990, Pages 1418-1421

https://doi.org/10.1016/S0196-0644(05)82611-3 Get rights and content

Study objective:

To evaluate emergency medical services (EMS) system use, injury mechanisms, and prehospital assessments among elderly victims of trauma.

Design:

We analyzed all prehospital data for injuries among patients 70 years old or older for whom 911 EMS dispatch was requested in a medium-sized metropolitan area during a 12-month period.

Results:

A total of 1,154 cases occurred (women, 65.1%), which represented 30.3% of all 911 dispatches involving elderly patients. Injury mechanisms were fall (60.7%), motor vehicle accident (MVA; 21.5%), fight (2.4%), accidental poisoning (2.3%), and choking (2.1%). Persons in their 90s had a lower frequency of MVAs (3.4%) than did younger patients (23.0%) (P < .005). The most frequent injuries determined by prehospital assessment were head or face (25.1%), upper extremity (17.2%), hip (14.5%), lower extremity (13.8%), back (9.8%), and chest or abdomen (5.0%). The frequency of serious neurologic injuries was less for falls or MVAs than for other mechanisms (P < .005). Suspected hip (P < .001) and pelvic (P < .005) injuries occurred more frequently during falls than during other mechanisms of injury, whereas back injuries occurred most frequently in MVAs (P < .001). Seventy-one fall victims (10.1%) had suspected medical causes of their fall. Twelve patients (1.0%) were in cardiac arrest.

Conclusion:

We report injury patterns and mechanisms among elderly victims of trauma presenting to an EMS system. A knowledge of these patterns will be useful to emergency physicians and EMS administrators.

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Women were more likely to have one injury, (to the neck/back, abdomen/pelvis or limbs), likely a fracture, compared with men who were more likely to sustain> 1 injury such as a luxation and/or contusion to their head [51]. Older adults fell more frequently than younger adults [9,38,40,41,51,66,83,97,113], from standing [12,14,17,27,28,30,31,60,69,85,118], slips [30,84,105,117], trips [30,105], low levels or stairs [90,118] and were often attended by alternative EMS, (e.g. ECPracs [14,17,81], specialist nurse or rapid response team [54], or emergency physicians [50]). The age-specific rate of falls was highest in adults ≥ 70 [57] and> 85 year olds [8,107] in both sexes, although women fell more often than men within the> 85 year old age group [8,107].
The ageing population is requiring more ambulance attendances for falls. This scoping review aimed to map and synthesise the evidence for the prehospital management of Emergency Medical Services (EMS) attended adult patients who fall.
The Joanna Briggs Institute methods for scoping reviews were used. Six databases were searched (Medline, Scopus, CINAHL, Cochrane, EMBASE, ProQuest), 1st August 2021. Included sources reported: ambulance attended (context), adults who fell (population), injuries, interventions or disposition data (concept). Data were narratively synthesised.
One-hundred and fifteen research sources met the inclusion criteria. Detailed information describing prehospital delivered EMS interventions, transport decisions and alternative care pathways was limited. Overall, adults< 65 years were less likely than older adults to be attended repeatedly and/or not transported. Being male, falling from height and sustaining severe injuries were associated with transport to major trauma centres. Older females, falling from standing/low height with minor injuries were less likely to be transported to major trauma centres.
The relationship between patient characteristics, falls and resulting injuries were well described in the literature. Other evidence about EMS management in prehospital settings was limited. Further research regarding prehospital interventions, transport decisions and alternative care pathways in the prehospital setting is recommended.
Chiropractic treatment of hand and wrist pain in older people: systematic protocol development. Part 2: cohort natural-history treatment trial
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This study examines (a) the feasibility of continued research with an older population; (b) the variety of hand-wrist conditions presented by older patients; (c) the accommodations to standard chiropractic treatment for older patients; and (d) the validity, reliability, responsiveness of measures, and preliminary estimates of outcome of treatment for general hand-wrist pain.
A cohort of 55 volunteers, first evaluated over a 5-week natural-history baseline period, was offered 5-week chiropractic treatment and then interviewed at 6 months posttreatment. Descriptive and preliminary inferential analyses are reported. Start values for power analysis are offered.
The project recruited a sample of 55 and retained 47 (85%) participants over 8 months, indicating feasibility of a larger project. Participants provided strong self-reported, albeit preliminary, evidence of benefit. Mean values and SDs of pain and strength measures are provided for future power calculations.
Clinical research with older participants presenting with hand-wrist pain and dysfunction is feasible. Validity, reliability, and responsiveness of self-reports are demonstrated. The research presents preliminary evidence of the benefit of chiropractic treatment for older patients presenting with hand-wrist symptoms.
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A small number of patients in the study had a suspected medical etiology as the reason for the trauma. The most common bodily site of injury was the head and face followed by the extremities [34]. Alcohol and other drugs may actually play an important role in contributing to geriatric trauma, especially falls and to a lesser extent motor vehicle collisions [35].
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This study investigated effects of step length on the stepping response used to arrest an impending forward fall. Twelve healthy young (mean age 22, S.D. 3.3 years) males participated by recovering balance with a single step following a forward lean-and-release. Participants were instructed to step to one of three floor targets representing small, natural, and large step lengths. The effect of step length was examined on the primary outcome variables: pushoff time, liftoff and landing time, swing duration, balance recovery time, landing impulse, and center of mass (COM) characteristics. Pushoff and liftoff times were not affected by step length, although swing phase duration, landing and recovery times and the anterior-posterior (AP) impulse at landing increased with increasing step length. The results support the idea of an invariant step preparation phase. Given that our participants naturally chose not to utilize a step as short as they were capable of employing, healthy young individuals do not minimize recovery time nor strength requirements when selecting their step length.

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: Presented at the University Association for Emergency Medicine Annual Meeting in Cincinnati, Ohio, May 1988.

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Original contributionGeriatric injury: An analysis of prehospital demographics, mechanisms, and patterns

Study objective:

Design:

Results:

Conclusion:

Ann Emerg Med

Am J Emerg Med

Ann Emerg Med

Falls among the elderly: A review of the methods and conclusions of epidemiologic studies

J Am Geriatr Soc

Geriatric trauma: Injury patterns and outcome

J Trauma

Injury in aged

NY State J Med

Analysis of life expectancy and living status of elderly patients surviving a burn injury

J Trauma

Original contribution
Geriatric injury: An analysis of prehospital demographics, mechanisms, and patterns