The Role of Emergency Department Physicians in Optimizing the Care and Management of the Elderly Trauma Patients: a 10-year Community Hospital Experience
Main Article Content
Abstract
INTRODUCTION:.
Emergency department (ED) physicians are positions at a critical place in the management of the elderly trauma patient, however their contribution can reach far beyond the ED room. We reviewed here the results of guidelines and recommendations utilized to care for our elderly trauma patients.
METHODS:.
A retrospective analysis of patients seen in the ED between 2012-2022. In addition to geographical data collected are length of stay, morbidity, mortality, medications used, comorbid conditions. Statistical analysis using students t-test, chi square and regression analysis with a significant “p” value at less than 0.05. Internal Review Board approval was obtained prior to the studies.
RESULTS:.
Of 375 elderly patients with fragility fracture seen in the ED, those who referred to the fracture liaison service (FLS) showed significant reduction in the refracture rate (p < 0.01) compared to those before establishment of the FLS. Those elderly patients with traumatic brain injury (TBI) who sustained less than 4 mm bleed and were not on anti-coagulation therapy can safely be observed in the ED for less than 23 hours and don’t need a repeat CT scan or neurosurgery consult. The presence of skull fracture is an ominous sign and should raise the ED physician’s suspicion for worse things to come.
CONCLUSIONS:..
Emergency department physicians’ role in the care of the elderly trauma patients can reach far beyond the immediate ED room treatment. When these recommendations and guidelines are implemented, it will have a positive long-term influence on the elderly trauma patient.
Article Details
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References
2. Evans DC, Gerlach AT, Christy JM, et al. Pre-injury polypharmacy as a predictor of outcomes in trauma patients. Int J Crit Illn Inj Sci. 2011;1(2): 104-109. doi: 10.4103/2229-5151.84793
3. Miller AN, Lake AF, Emory CL. Establishing a fracture liaison service: An orthopaedic approach. J Bone Joint Surg Am. 2015;97(7):675-681.
4. Alswat KA. Gender disparities in osteoporosis. J Clin Med Res. 2017;9(5):382-387. doi: 10.14740/jocmr2970w
5. US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for osteoporosis to prevent fractures: US preventive services task force recommendation statement. JAMA. 2018;319(24): 2521-2531. doi: 10.1001/jama.2018.7498
6. Brenneman SK, Barrett-Connor E, Sajjan S, Markson LE, Siris ES. Impact of recent fracture on health-related quality of life in postmenopausal women. J Bone Miner Res. 2006;21(6):809-816. doi: 10.1359/jbmr.060301
7. Jackson A , Wasfie T, Brock C, et al. Fragility Vertebral Compression Fractures in Postmenopausal Women: The Role of a Fracture Liaison Service Program. The American Surgeon 2020; 86(12) 1636-1639. Doi: 10.1177/0003134820933254
8. Kanis JA on behalf of the World Health Organization Scientific Group (2007). Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK. 2007:Printed by the University of Sheffield.
9. Singer A, Exuzides A, Spangler L, et al. Burden of Illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. Mayo Clin Proc. 2015; 90(1):53-62. doi: 10.1016/j.mayocp.2014.09.011.
10. Lyritis GP, Mayasis B, Tsakalakos N, et al. The natural history of the osteoporotic vertebral fracture. Clin Rheumatol. 1989;8 Suppl 2:66-69. doi: 10.1007/BF02207237
11. Wasfie T, Jackson A, Brock C, et al. Does a fracture liaison service program minimize recurrent fragility fractures in the elderly with osteoporotic vertebral compression fractures? The American Journal of Surgery 2018.
http://doi.org/10.1016/j.amjsurg2018.09.027
12. Frontera JA, Egorova N, Moskowitz AJ. National trend in prevalence, cost, and discharge disposition after subdural hematoma from 199/2007. Crit Care Med. 2011;39(7):1619-1625.
13. Kalanithi P, Schubert RD, Lad SP, Harris OA, Boakye M. Hospital costs, incidence, and hospital mortality rates of traumatic subdural hematoma in the United States. J Neurosurg. 2011;115(5):1013-1018.
14. Canner JK, Giuliano K, Gani F, Schneider EB. Thirty-day re-admission after traumatic brain injury: Results from MarketScan. Brain Inj. 2016;30 (13-14):1570-1575.
15. Joseph B, Aziz H, Pandit V, et al. Prospective validation of the Brain Injury Guidelines: managing traumatic brain injury without neurosurgical consultation. J Trauma Acute Care Surg. 2014;77 (6): 984-988.
16. Wasfie T, Korbitz H, Odowd B, et al. Validation of Brain Injury Guidelines in the Elderly Trauma Patient Presenting at a Level Two Trauma Center. The American Surgeon. 2023; 0(0) 1-3. doi: 10.1177/0003134823161676
17. Kehoe A, Smith JE, Bouamra O, Edwards A, Yates D, Lecky F. Older patients with trauma brain injury present with a higher GCS score than younger patients for a given severity of injury. Emerg Med J 2016;33(6):381-5.
https://doi.org/10.1136/emermed-2015-205180
18. Bick H, Wasfie T, Labond V, et al. Traumatic brain injury in the elderly with high Glasgow coma scale and low injury severity scores: Factors influencing outcomes. American Journal of Emergency Medicine 2022; 51, 354-357.
19. Hamilton M, Wallace C. Nonoperative management of acute epidural hematoma diagnosed by CT: the neuroradiologist’s role. Am J Neuroradiol. 1992:13(3):853-859.
20. Wasfie T, Ho T, Shapiro B. Acute Traumatic Epidural Hematoma in the Elderly: A Community Hospital Experience. The American Surgeon 2020; 00(0) 1-2. doi: 10.1177/0003134820943117.
21. Zatzick DF, Rowhani-Rahbar A, Wang J, Russo J, Darnell D, Ingraham L, et al. The cumulative burden of psychiatric substance use and medical disorders and re-hospitalization and mortality after injury. Psychatr Serv. 2017 June 01:68(6):596-602