Background: Trauma is a major public health problem with huge economic and social implications. Old age and co-morbidities generally affect the outcome of traumatic injuries in elderly patients, and the impact of trauma on elderly patients has generally been overlooked.
Objective: To describe the epidemiology and outcome of trauma on elderly patients.
Design: This was a retrospective study that was conducted at Cedarcrest Hospitals, Abuja, Nigeria.
Method: Data were collected from the electronic medical records for all patients aged 65 years and above who visited the emergency department as a result of traumatic injuries.
Results: A total of 82 patients were recruited for the study. The prevalence of geriatric trauma was 4.9%, and fall was the commonest mechanism of injury (67.1%). Ninety eight point eight percent had a revised trauma score of 12 while the injury severity score ranged from 1 to 15.
Conclusion: Geriatric trauma is relatively common in our environment and efforts should be made to prevent falls in the elderly

Ekwe, K.

Ogbu, V.O.

Ogedegbe, F.

English

AJOL - African Journals Online

77East African Orthopaedic JournalABSTRACT Background:  Trauma is a major public health problem with huge economic and social implica ons. Old age and co-morbidi es generally affect the outcome of trauma c injuries in elderly pa ents, and the impact of trauma on elderly pa ents has generally been overlooked.Objec ve:  To describe the epidemiology and outcome of trauma on elderly pa ents.Design:  This was a retrospec ve study that was conducted at Cedarcrest Hospitals, Abuja, Nigeria. Method:  Data were collected from the electronic medical records for all pa ents aged 65 years and above who visited the emergency department as a result of trauma c injuries.Results:  A total of 82 pa ents were recruited for the study. The prevalence of geriatric trauma was 4.9%, and fall was the commonest mechanism of injury (67.1%). Ninety eight point eight percent had a revised trauma score of 12 while the injury severity score ranged from 1 to 15.Conclusion:  Geriatric trauma is rela vely common in our environment and efforts should be made to prevent falls in the elderly. Key words: Geriatric trauma, Epidemiology, OutcomeGERIATRIC TRAUMA - EPIDEMIOLOGY AND OUTCOME AT CEDARCREST HOSPITALS, ABUJA, NIGERIAV.O. Ogbu, MBBS, FWACS (Orth & Trauma), FMCOrth, F. Ogedegbe, MBBS, FWACS (Orth & Trauma) and          K. Ekwe, MBBS, FWACS (Orth & Trauma), Cedarcrest Hospitals, Abuja, NigeriaCorrespondence to: Dr. Valen ne O. Ogbu, Cedarcrest Hospitals, Abuja, Nigeria.  Email: voogbu@gmail.comINTRODUCTIONGeriatric trauma is rapidly becoming a major healthcare concern, and the number of geriatric trauma is increasing as the popula on ages (1,2). Trauma is a major surgical disease and mostly affects young people, the ac ve age group. Nigeria, a developing country has a young popula on and the burden of trauma in individuals aged more than 65 years is either under-researched or overlooked. Preven on of communicable diseases and maternal and child health have been the major thrust of government health policy. The propor on of elderly pa ents will con nue to increase in Nigeria as the economic condi on of the country improves. The elderly are prone to injuries because of physical changes associated with ageing like poor vision, hearing loss and decline in neurocogni ve func on (3). A number of factors are known to contribute to the poor prognosis of geriatric trauma. This includes underlying co-morbidi es, mul ple drug use and poor physiological reserve (4,5). Geriatric re-habilita on centres are almost non-existent in Nigeria, and this impacts nega vely on the outcome of care. The German Society of Trauma and Orthopaedics has suggested the idea of building specific trauma centres in order to improve the outcome of care in the elderly (6). This study aims to describe the epidemiology and outcome of trauma on elderly pa ents as seen at Cedarcrest Hospitals Abuja, Nigeria.MATERIALS AND METHODSThis was an observa onal retrospec ve study st thconducted from 1  January 2018 to 30  September 2021 at Cedarcrest Hospitals, a private hospital in Abuja, Nigeria. Data were collected from the electronic medical records of the hospital. All pa ents aged 65 years and above who visited the Emergency Department (ED) as a result of trauma c injuries were included in the study. Pa ents who presented with trauma c injuries and died shortly a er the presenta on in the ED were excluded. Data collected included age, gender, ini al vital signs, Glasgow Coma Scale, type of injury, cause of injury, Injury Severity Score (ISS), revised trauma score and mortality rate. ISS is an anatomical scoring system that makes use of an Abbreviated Injury Scale (AIS). The AIS divides the body into six regions, and a coded value is given to each region based on the severity of the injuries. In calcula ng the ISS, the three most injured body regions using the AIS are selected. The highest AIS score for each body region is then squared and the scores summed. ISS ranges from 1 to 75 (7).   Research articleVolume 16 No. 2, September 202278It is a good predictor of mortality and the threshold for major trauma is ISS greater than 15 (8).       The RTS is a physiological scoring system based on systolic blood pressure, respiratory rate and Glasgow coma scale. It is calculated by adding the coded values of the components (GCS, RR, SBP). The scores range from 0 to 12 (9). It is a triage tool in iden fying seriously injured pa ents in the emergency unit, and an RTS <11 indicates a survival rate of less than 90% (10).     The outcome measures were trauma-related mortality rate, length of hospital stay, complica on and ICU admission rate. Data was analyzed using SPSS version 23 and the results are presented in tables and figures.RESULTSA total of 82 pa ents were recruited for the study. There were 42 males and 40 females with male to female ra o of 1.05:1. Majority of the pa ents who sustained trauma were within the age range of 65–70 years old and made up approximately 34.1% of the total study sample size (Table 1). A total of one thousand six hundred and seventy two pa ents with trauma c injuries were seen in the Emergency Department during the study period. Thus, the  prevalence rate of geriatric trauma was 4.9%.East African Orthopaedic JournalVolume 16 No. 2, September 2022Table 1Age distribu on across the sample size and gender groupsFigure 1Distribu on of mechanism of injuryX-squared = 8.1714, df = 5, p-value =0.147  Fall was the commonest mechanism of injury accoun ng for 67.1% of the popula on (Figure 1). Further categoriza on of fall as a mechanism of injury showed that majority of the pa ents (25.5%) fell in the bathroom (Figure 2). Fall Road traffic accident  Not clearly stated  79East African Orthopaedic JournalVolume 16 No. 2, September 2022Figure 2Evalua on of fall as a mechanism of injuryTable 2Analysis of Injury Severity Score (ISS)Analysis of the severity of injuries using the Revised Trauma Score, a physiologic scoring system showed that 98.8% of the pa ents were labelled as delayed while 1.2% needed urgent care. Fi y one point two percent of the pa ents had an Injury Severity Score of 9 while only one pa ent had a score of 15 (Table 2).        Limb fracture was the commonest injury recorded. It was seen in 84.7% of the pa ents, while 1 pa ent had head injury (Figure 3).  Injury severity score80East African Orthopaedic JournalVolume 16 No. 2, September 2022Further analysis of the limb fractures showed that proximal femoral fractures were the commonest (Table 3). It had the following distribu ons: intertrochanteric fractures (25.6%) and neck of femur fractures (14.1%). One pa ent with proximal femoral fracture did not have surgery and others had the following procedures: DHS with side plate (54.8%), total hip replacement (32.3%), proximal femoral interlocked nailing (9.7%).The average length of hospital stay was 7 days (Table 4). The mortality and ICU admission rates were 1.2% and 2.4% respec vely.Figure 3Categoriza on of injuriesTable 3Categoriza on of limb fractures81East African Orthopaedic JournalVolume 16 No. 2, September 2022DISCUSSIONThe low prevalence of geriatric trauma 4.9% in our study is in keeping with the overall demographic severity in our country, which has a mean life expectancy of 55.75 years (11). Onyedika et al. (12) had reported a prevalence rate of 4% among geriatric pa ents in a na onal trauma centre in Abuja. The popula on is aging in the western world and this has significantly increased the propor on of pa ents presen ng with major trauma (13). A large scale study in Europe involving 22,549 pa ents reported trauma in the form of home injuries or car accidents in 20.2% of those between 65 and 103 years of age (14). Geriatric trauma has a higher male pre-ponderance (1,12). The adventurous nature of men has been suggested as the reason for this (12). All our pa ents had blunt trauma. This is mostly because of the peaceful co-existence in the ci es notwith-standing high level of insurgency in Nigeria. This is in contrast to the high prevalence of penetra ng trauma in the elderly and assault rate of 25.3% in South Africa which has a high rate of inter-personal trauma (15).      In assessing the severity of the trauma, 98.8% of pa ents had a Revised Trauma Score (RTS) of 12. This showed that a greater number of geriatric pa ents do not present with immediately life-threatening condi ons and are categorized as delayed. They usually have less injury pa erns (12,16). Only one pa ent had an Injury Severity Score (ISS) of 15. Various mechanisms of injury have been described by other authors. Fall has been noted as the leading mechanism of injury in several studies (4,16,17). This is similar to our study where 67.1% of injuries were as a result of fall. Unsteady gait, arthri c joints, poor vision and drug therapies have been a ributed as the reasons for the frequent fall seen in elderly pa ents (4). In the further categoriza on of where the fall took place, we noted that 25.5% of the falls occurred at the bathroom and this was a ributed to wet and slippery floor. Motor vehicular crashes and road traffic-related accidents have also been reported in some parts of Africa and other parts of the world as the leading cause of trauma in geriatrics (12,17,19). In other clime where the crime rate is higher, assault has been reported as the leading mechanism of injury. A study of geriatric injuries among pa ents a ending a regional hospital in Tanzania reported that 52.1% of the injuries were as a result of assault (20).In analysing the injury pa erns, fractures, Trauma c Brain Injury (TBI) and so   ssue injuries have variously been reported. Okoye et al. (12) in a study in Abuja reported as follows: TBI 24.3%, so   ssue injuries 22.1%, fracture-disloca on 20.4%.  While Chalya et al. (20) in Tanzania reported fractures in 52.2% of the pa ents. TBI has been reported as the most common  injury in other parts of the world (16,21,22). The reason for this varia on in the pa ern of injuries seen the geriatric could not easily be explained by the exis ng literature. Limb fracture was the commonest injury in our study accoun ng for 84.7% of the injuries sustained. Our hospital is a leading orthopaedic trauma centre in Abuja and this could have influenced the pa ern of injuries noted in the study. A review of the fracture pa erns showed that proximal femoral fractures accounted for 39.7% of the injuries. This may be a ributed to the high prevalence of age-related osteoporosis in the elderly (23).Table 4Length of hospital stay82East African Orthopaedic JournalVolume 16 No. 2, September 2022      In reviewing the outcome of care, ICU admission, LOS, and mortality rate have been used by other authors. A higher mortality rate has been reported in elderly pa ents following trauma (20,22,24).  Mortality rates as high as 14.9% and 11.4% have been reported in Tanzania and South Africa (15,20). Elderly pa ents fare less than the younger pa ents because of the poor physiologic reserve, the ageing process, burden of co-morbidi es and pre-exis ng illness. We reported a low mortality rate of 1.2% and this could be explained by the low ISS which ranged from 1 to 15 and the fact that none of the pa ents had ven latory support in our study. The mortality rate is significantly related to high ISS and the need for ven latory support (5,21). Our average LOS was 7 days. This is against 28.6 days and 2.96 days reported in Tanzania and South Africa (15,20). LOS is significantly higher in pa ents with co-morbidi es, long bone fractures and complica ons (19).      The study has its limita on which included that the long-term outcome of care given to geriatric pa ents was not studied. Future studies should aim at reviewing func onal outcomes and quality of life a er discharge.CONCLUSIONIn this study, we have found that geriatric trauma are usually not life threatening at presenta on. A good number of them present with hip and inter-trochanteric fractures following fall at home. Every effort should be made to create a safe environment at home.REFERENCES1. Adams, S.D. and Holcomb, J.B. Geriatric trauma. Curr Opin Crit Care. 2015; 21(6):520–526.2. Jiang, L., Zheng, Z. and Zhang, M. The incidence of geriatric trauma is increasing and comparison of different scoring tools for the predic on of in-hospital mortality in geriatric trauma pa ents. 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DOI:h p://dx.doi.org/10.4314/thrb. v14i1.4.21. Gioffre-Florio, M., Murabito, L.M., Visalli, C., Pergohzzi, F.P. and Fama, F. Trauma in elderly pa ents: a study of prevalence, co-morbidi es and gender differences. G Chir.2018;39(1):35-40.22. Raul, C.S., Lin, T.S., Wu, S.C., Yang, J.C.S., SY Hsu, S.Y., et al. Geriatric hospitaliza ons in fall related injuries. Scand J Trauma Resusc Emerg Med. 2014: 22: 63.23. Li, G., Thabane, L., Papaioannou, A., et al. An overview of osteoporosis and frailty in the elderly. BMC Musculoskelet Disord. 2017; 18:46. h ps://doi.org/10.1186/s12891-017-140.24. .Hashmi, A., Ibrahim Zaba, J., Rhee, P., Aziz, H., Fani, M.J. Fries, R.S., et al. Predictor of mortality in geriatric trauma pa ents: a systema c review and meta-analysis. J Trauma Acute Care Surg. 2014; 76:894-890. East African Orthopaedic Journal

Geriatric trauma - epidemiology and outcome at Cedarcrest Hospitals, Abuja, Nigeria

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Geriatric trauma - epidemiology and outcome at Cedarcrest Hospitals, Abuja, Nigeria

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