Elderly trauma mortality in a resource-limited setting: A benchmark for process improvement.
Elderly trauma
Sub-Saharan Africa
Trauma
Journal
Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
26
03
2021
revised:
07
06
2021
accepted:
01
07
2021
pubmed:
18
7
2021
medline:
9
9
2021
entrez:
17
7
2021
Statut:
ppublish
Résumé
As life expectancy improves globally, the burden of elderly trauma continues to increase. Sub-Saharan Africa is projected to have the most rapid growth in its elderly demographic. Consequently, we sought to examine the trends in characteristics and outcomes of elderly trauma in a tertiary care hospital in Malawi. We performed a retrospective analysis of adult patients in the trauma registry at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from 2011-2017. Patients were categorized into elderly (≥ 65 years) and non-elderly (18-64 years). Bivariate analysis compared the characteristics and outcomes of elderly vs. non-elderly patients. The elderly population was then examined over the study period. Poisson regression modeling was used to determine the risk of mortality among elderly patients over time. Of 63,699 adult trauma patients, 1,925 (3.0%) were aged ≥ 65 years. Among the elderly, the most common mechanism of injury was falls (n = 725 [37.7%]) whereas vehicle or bike collisions were more common in the non-elderly (n = 15,967 [25.9%]). Fractures and dislocations were more prevalent in the elderly (n = 808 [42.0%] vs. 9,133 [14.8%], p < 0.001). In-hospital crude mortality for the elderly was double the non-elderly group (4.8% vs. 2.4%, p < 0.001). Elderly transfers, surgeries, and length of stay significantly increased over the study period but mortality remained relatively unchanged. When adjusted for injury severity and transfer status, there was no significant difference in risk of in-hospital mortality over time. At KCH, the proportion of elderly trauma patients is slowly increasing. Although healthcare resource utilization has increased over time, the overall trend in mortality has not improved. As the quality of care for the most vulnerable populations is a benchmark for the success of a trauma program, further work is needed to improve the trend in outcomes of the elderly trauma population in Malawi.
Identifiants
pubmed: 34272049
pii: S0020-1383(21)00606-9
doi: 10.1016/j.injury.2021.07.001
pmc: PMC8429241
mid: NIHMS1722582
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2651-2656Subventions
Organisme : FIC NIH HHS
ID : D43 TW009340
Pays : United States
Informations de copyright
Copyright © 2021. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors has no conflict of interest to disclose. The author has no financial relationships to disclose.
Références
BMC Med Res Methodol. 2018 Jun 22;18(1):63
pubmed: 29929477
J Trauma Acute Care Surg. 2012 Nov;73(5 Suppl 4):S345-50
pubmed: 23114492
S Afr Med J. 2019 Dec 12;110(1):44-48
pubmed: 31865942
Surgery. 2017 Dec;162(6S):S45-S53
pubmed: 28385178
Injury. 1990 Jul;21(4):234-8
pubmed: 2228196
Emerg Med Clin North Am. 2016 Aug;34(3):483-500
pubmed: 27475011
Arch Acad Emerg Med. 2019 Jan 15;7(1):e6
pubmed: 30847441
J Trauma Acute Care Surg. 2018 Feb;84(2):301-307
pubmed: 29251704
World J Surg. 1996 Oct;20(8):1113-9; discussion 1119-20
pubmed: 8798374
BMC Geriatr. 2019 Dec 19;19(1):359
pubmed: 31856739
Afr Health Sci. 2018 Mar;18(1):79-89
pubmed: 29977261
PLoS One. 2021 Jan 22;16(1):e0245779
pubmed: 33481891
East Afr Med J. 2001 Aug;78(8):441-4
pubmed: 11921570
PLoS One. 2018 Aug 3;13(8):e0199219
pubmed: 30074996
J Emerg Trauma Shock. 2016 Jul-Sep;9(3):122-5
pubmed: 27512334
J Am Geriatr Soc. 2014 Aug;62(8):1460-6
pubmed: 25041242
World J Surg. 2019 Feb;43(2):466-475
pubmed: 30238387
World J Surg. 2020 Jul;44(7):2108-2115
pubmed: 32166470
J Safety Res. 2011 Dec;42(6):461-72
pubmed: 22152264
Neuroepidemiology. 2010;35(1):12-6
pubmed: 20339306
Gerontol Geriatr Educ. 2015;36(1):14-29
pubmed: 24884474
Emerg Med Clin North Am. 2006 May;24(2):413-32, vii
pubmed: 16584964
Glob Health Action. 2013 Jan 24;6:19305
pubmed: 23364087
Am Fam Physician. 2017 Aug 15;96(4):240-247
pubmed: 28925664
World J Crit Care Med. 2017 May 4;6(2):99-106
pubmed: 28529911
Inj Prev. 2002 Jun;8(2):133-6
pubmed: 12120832
Am J Epidemiol. 2004 Apr 1;159(7):702-6
pubmed: 15033648
Tanzan J Health Res. 2012 Jan;14(1):15-20
pubmed: 26591742
Injury. 2019 Sep;50(9):1552-1557
pubmed: 31301812
World J Surg. 2016 Nov;40(11):2650-2657
pubmed: 27386866
Clin Geriatr Med. 2013 Feb;29(1):137-50
pubmed: 23177604
East Afr Med J. 2001 Mar;78(3):161-4
pubmed: 12002059
S Afr Med J. 2006 Aug;96(8):718-21
pubmed: 17019495
J Emerg Trauma Shock. 2014 Oct;7(4):261-7
pubmed: 25400386
Arch Gerontol Geriatr. 2015 Sep-Oct;61(2):231-9
pubmed: 26043957
Ann Emerg Med. 2004 Aug;44(2):108-13
pubmed: 15278081
Br J Surg. 2002 Oct;89(10):1319-22
pubmed: 12296905
J Trauma Acute Care Surg. 2014 Mar;76(3):894-901
pubmed: 24553567
BMC Anesthesiol. 2018 Aug 25;18(1):118
pubmed: 30144794
Am J Public Health. 1995 Jul;85(7):927-31
pubmed: 7604915
J Trauma Acute Care Surg. 2016 Jul;81(1):196-206
pubmed: 26958795