Gerard A Baltazar, Parker Bassett, Amy J Pate, Akella Chendrasekhar
{"title":"Older patients have increased risk of poor outcomes after low-velocity pedestrian-motor vehicle collisions.","authors":"Gerard A Baltazar, Parker Bassett, Amy J Pate, Akella Chendrasekhar","doi":"10.2147/POR.S127710","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Motor vehicle collisions (MVCs) are a leading cause of injury in the US. While the probability of collision with a pedestrian (PMVC) has declined in recent years, the probability of a pedestrian fatality has risen. Our objective was to determine whether older age impacts potential outcomes in patients involved in low-velocity PMVCs.</p><p><strong>Materials and methods: </strong>We performed a retrospective-cohort study of adult patients aged >14 years involved in low-velocity pedestrian-MVCs (<15 miles per hour [24.14 km/h]), presenting to an urban level I trauma center from January to November 2013. Subjects were identified via trauma registry and stratified: ages 15-49 years and ≥50 years. Electronic medical records were reviewed for demographics, vital signs, and laboratory results on initial presentation, presence or absence of systemic inflammatory response syndrome (SIRS), shock index (SI), injury-severity score (ISS), length of stay (LOS), and survival to discharge. For statistical analysis, <i>χ</i><sup>2</sup> or Student's <i>t</i>-tests were utilized.</p><p><strong>Results: </strong>Our study included 145 patients (77 female) with a mean age of 41.9±3 years; 95 patients were aged 15-49 years (mean 31.9±2.2 years), and 50 patients were aged ≥50 years or older (mean 62.44±2.9 years). Mean ISS was 10.05±1.95, mean SI was 0.68±0.03, and mean LOS was 3.67±0.57 days. A total of 41 patients met SIRS criteria on arrival, and nine patients expired (6.2%). Mean ISS (15.64±4.42 vs 7.1±1.64, <i>P</i><0.001) and mean SI (0.75±0.07 vs 0.65±0.03, <i>P</i>=0.002) were higher in patients aged ≥50 years. Mean LOS was longer in older patients (5.22±1.14 vs 2.85±0.58 days, <i>P</i><0.001). Older age was associated with SIRS on arrival (<i>P</i>=0.023) and associated with mortality (<i>P</i>=0.004).</p><p><strong>Conclusion: </strong>Age ≥50 years is associated with greater severity of injury and poor outcomes for patients involved in low-velocity PMVCs. Increased clinical attention and resource allocation should be directed toward older patients after low-velocity PMVCs.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2017-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S127710","citationCount":"3","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pragmatic and Observational Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/POR.S127710","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2017/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 3
Abstract
Background: Motor vehicle collisions (MVCs) are a leading cause of injury in the US. While the probability of collision with a pedestrian (PMVC) has declined in recent years, the probability of a pedestrian fatality has risen. Our objective was to determine whether older age impacts potential outcomes in patients involved in low-velocity PMVCs.
Materials and methods: We performed a retrospective-cohort study of adult patients aged >14 years involved in low-velocity pedestrian-MVCs (<15 miles per hour [24.14 km/h]), presenting to an urban level I trauma center from January to November 2013. Subjects were identified via trauma registry and stratified: ages 15-49 years and ≥50 years. Electronic medical records were reviewed for demographics, vital signs, and laboratory results on initial presentation, presence or absence of systemic inflammatory response syndrome (SIRS), shock index (SI), injury-severity score (ISS), length of stay (LOS), and survival to discharge. For statistical analysis, χ2 or Student's t-tests were utilized.
Results: Our study included 145 patients (77 female) with a mean age of 41.9±3 years; 95 patients were aged 15-49 years (mean 31.9±2.2 years), and 50 patients were aged ≥50 years or older (mean 62.44±2.9 years). Mean ISS was 10.05±1.95, mean SI was 0.68±0.03, and mean LOS was 3.67±0.57 days. A total of 41 patients met SIRS criteria on arrival, and nine patients expired (6.2%). Mean ISS (15.64±4.42 vs 7.1±1.64, P<0.001) and mean SI (0.75±0.07 vs 0.65±0.03, P=0.002) were higher in patients aged ≥50 years. Mean LOS was longer in older patients (5.22±1.14 vs 2.85±0.58 days, P<0.001). Older age was associated with SIRS on arrival (P=0.023) and associated with mortality (P=0.004).
Conclusion: Age ≥50 years is associated with greater severity of injury and poor outcomes for patients involved in low-velocity PMVCs. Increased clinical attention and resource allocation should be directed toward older patients after low-velocity PMVCs.
背景:机动车碰撞(MVCs)是美国伤害的主要原因。虽然近年来行人碰撞的概率(PMVC)有所下降，但行人死亡的概率却有所上升。我们的目的是确定年龄是否会影响低速pmvc患者的潜在预后。材料和方法:我们对年龄>14岁的低速行人mvcs成人患者进行了回顾性队列研究(采用χ2或学生t检验)。结果:纳入145例患者，其中女性77例，平均年龄41.9±3岁;年龄15 ~ 49岁95例(平均31.9±2.2岁)，年龄≥50岁50例(平均62.44±2.9岁)。平均ISS为10.05±1.95天，平均SI为0.68±0.03天，平均LOS为3.67±0.57天。41例患者到达时符合SIRS标准，9例患者死亡(6.2%)。年龄≥50岁患者的平均ISS(15.64±4.42 vs 7.1±1.64,PP=0.002)较高。老年患者的平均LOS较长(5.22±1.14 vs 2.85±0.58天，PP=0.023)，且与死亡率相关(P=0.004)。结论:年龄≥50岁与低速PMVCs患者损伤严重程度和预后不良相关。增加临床关注和资源分配应针对低速PMVCs后的老年患者。
期刊介绍：
Pragmatic and Observational Research is an international, peer-reviewed, open-access journal that publishes data from studies designed to closely reflect medical interventions in real-world clinical practice, providing insights beyond classical randomized controlled trials (RCTs). While RCTs maximize internal validity for cause-and-effect relationships, they often represent only specific patient groups. This journal aims to complement such studies by providing data that better mirrors real-world patients and the usage of medicines, thus informing guidelines and enhancing the applicability of research findings across diverse patient populations encountered in everyday clinical practice.
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