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Analysis of geriatric patients with minor spinal trauma admitted to the emergency department of a university hospital

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13.10.2020 Analys s of ger atr c pat ents w th m nor sp nal trauma adm tted to the emergency department of a un vers ty hosp tal :Tufan Ak n G …

www.jadweb.org/pr ntart cle.asp? ssn=2221-6189;year=2019;volume=8; ssue=5;spage=191;epage=194;aulast=G ray 1/4

ORIGINAL ARTICLE

Year : 2019 | Volume : 8 | Issue : 5 | Page : 191--194

Analys s of ger atr c pat ents w th m nor sp nal trauma adm tted to the

emergency department of a un vers ty hosp tal

Tufan Ak n G ray1, Afs n Emre Kay pmaz2, Erk n Sonmez3, Kemal Murat Haberal4, Cem Y lmaz3, Cem l Kavalc5, Hakan Oguzturk2,

1 Ist nye Un vers ty Faculty of Med c ne, Department of Emergency, Istanbul, Turkey 2 Ankara C ty Hosp tal, Department of Emergency, Ankara, Turkey

3 Baskent Un vers ty Faculty of Med c ne, Department of Neurosurgery, Ankara, Turkey 4 Baskent Un vers ty Faculty of Med c ne, Department of Rad od agnost c, Ankara, Turkey 5 Baskent Un vers ty Faculty of Med c ne, Department of Emergency, Ankara, Turkey

Correspondence Address:

Afs n Emre Kay pmaz

Ankara C ty Hosp tal, Department of Emergency, Ankara Turkey

Abstract

Object ve: To retrospect vely analyze pat ents aged 65 years and over, who were adm tted to a level II trauma center n Turkey due to m nor sp nal trauma n a per od of 4 years. Methods: The study ncluded 64 pat ents aged 65 years and over, who were adm tted to the Emergency Department of Baskent Un vers ty Ankara Hosp tal between January 2011 and January 2015 and d agnosed w th vertebral trauma. The nformat on of the pat ents was obta ned from the med cal records. The cl n cal character st cs of pat ents nclud ng local zat ons and types of fracture, presence of add t onal system njur es and treatment opt ons were nvest gated. Results: The most common cause was fall, account ng for 51 (79.7%), w th 7 (10.9%) due to ntra-veh cle traff c acc dent, and 6 (9.4%) due to out-of-ntra-veh cle pedestr an njury. The most common s te of trauma was the lumbar reg on. Of the fractures, 46.9% (n=30) were n the lumbar reg on, 37.5% (n=24) n the thorac c reg on and 15.6% (n=10) were n the cerv cal vertebra reg on. Fourteen (21.9%) pat ents had an add t onal njury. G ven the fracture types, 47 fractures (74.6%) were compress on, 14 fractures (22.2%) were sp nous process and 2 fractures (3.2%) were burst fractures. Twenty pat ents (31.2%) had mult level vertebral fractures. Conclus ons: The results of our study demonstrated the mportance of vertebral fractures n the ger atr c age group. In th s age group, falls and motor veh cle acc dents are the lead ng causes of vertebral traumas. Tak ng the necessary measures to prevent the r sk factors wh ch ncrease w th ag ng s the most mportant step n prevent ng the mortal ty and morb d ty that may occur as a result of vertebral fracture.

How to c te th s art cle:

G ray TA, Kay pmaz AE, Sonmez E, Haberal KM, Y lmaz C, Kavalc C, Oguzturk H. Analys s of ger atr c pat ents w th m nor sp nal trauma adm tted to the emergency department of a un vers ty hosp tal.J Acute D s 2019;8:191-194

How to c te th s URL:

G ray TA, Kay pmaz AE, Sonmez E, Haberal KM, Y lmaz C, Kavalc C, Oguzturk H. Analys s of ger atr c pat ents w th m nor sp nal trauma adm tted to the emergency department of a un vers ty hosp tal. J Acute D s [ser al onl ne] 2019 [c ted 2020 Oct 13 ];8:191-194

Ava lable from: http://www.jadweb.org/text.asp?2019/8/5/191/268407

Full Text

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13.10.2020 Analys s of ger atr c pat ents w th m nor sp nal trauma adm tted to the emergency department of a un vers ty hosp tal :Tufan Ak n G …

www.jadweb.org/pr ntart cle.asp? ssn=2221-6189;year=2019;volume=8; ssue=5;spage=191;epage=194;aulast=G ray 2/4 Trauma has been one of the lead ng causes of emergency department adm ss ons[1]. As l fe expectancy ncreases w th each pass ng year, adm ss ons of ger atr c pat ents aged 65 years and over, espec ally pat ents w th ger atr c trauma n emergency department are becom ng more frequent[2]. Akoglu et al. reported that 22% of the pat ents presented to the emergency department of a un vers ty hosp tal w th trauma were ger atr c pat ents[3].

Trauma cases n the ger atr c age group result n h gher mortal ty and morb d ty compared to other age groups. These pat ents are at r sk of traumas due to underly ng system c d seases and reduced phys olog cal reserves[4]. These r sk factors form a bas s for falls and motor veh cle acc dents, wh ch are the lead ng causes of trauma n the ger atr c populat on.

Determ n ng the frequency of sp nal traumas and concom tant system c njur es n the ger atr c age group w ll help to take necessary measures to prevent the r sks. By correct ng the preventable causes of ger atr c traumas, the morb d ty and mortal ty that may develop due to traumas can be prevented.

The a m of our study s to retrospect vely analyze pat ents aged 65 years and over, who were adm tted to a level II trauma center n Turkey due to m nor sp nal trauma n a per od of 4 years.

2. Mater als and methods

Th s cross-sect onal, observat onal study was conducted retrospect vely after obta n ng the approval of the eth cs comm ttee (The approval number: KA 15/70). The study ncluded 64 pat ents aged 65 years and over who were adm tted to the Adult Emergency Department of Baskent Un vers ty Ankara Hosp tal between January 2011 and January 2015 and d agnosed w th vertebral trauma. The nformat on of the pat ents ncluded n the study was obta ned from the med cal records and hosp tal automat on system. The cl n cal character st cs of pat ents nclud ng local zat ons and types of fracture, presence of add t onal system njur es and treatment opt ons were nvest gated.

The data were analyzed us ng the SPSS 17.0 software for W ndows. Descr pt ve var ables were expressed as “n”, percentage (%).

3. Results

There were a total of 64 pat ents aged 65 years and over, who were d agnosed w th vertebral fracture between January 2011 and January 2015. Of the pat ents, 17 (26.6%) were between 65-74 years of age and 26 (40.6%) were between 75-84 years of age, wh le 21 (32.8%) were older than 85 years of age. Of the pat ents, 35.9% (n=23) were male and 64.1% (n=41) were female. Of the pat ents, 32.8% (n=21) were adm tted n autumn, 25% (n=16) n summer, 23.4% (n=15) n spr ng, and 18.8% (n=12) were adm tted n w nter.

The most common cause was fall. Of the pat ents, 51 (79.7%) were exposed to vertebral njury due to fall, 7 (10.9%) due to ntra-veh cle traff c acc dent, and 6 (9.4%) were exposed to vertebral njury due to out-of-ntra-veh cle pedestr an njury. The most common s te of trauma was the lumbar reg on. Of the fractures, 46.9% (n=30) were n the lumbar reg on, 37.5% (n=24) n the thorac c reg on and 15.6% (n=10) were n the cerv cal vertebral reg on. Fourteen (21.9%) of the pat ents had an add t onal njury. Moreover, 4 pat ents (6.3%) had ntracran al hemorrhage, 7 pat ents (10.9%) had thorac c trauma, and 7 pat ents (10.9%) had extrem ty trauma. Cons der ng the add t onal system c njury, add t onal njury was most commonly present n pat ents aged 75-84 years.

A total of 1 pat ent (1.6%) had pneumothorax, 3 pat ents (4.7%) had pulmonary contus on, 6 pat ent (9.4%) had costal fracture, 1 pat ent (1.6%) had ep dural hemorrhage, 1 pat ent (1.6%) had subdural hemorrhage, 1 pat ent (1.6%) had subarachno d hemorrhage, 1 pat ent (1.6%) had cerebral edema, and three pat ents (4.7%) had pelv c fracture. None of the pat ents had hemothorax, spleen or l ver lacerat on.

None of the pat ents had abdom nal njury.

Wh le 45 pat ents (70.3%) were d scharged from the emergency department, 12 pat ents (18.7%) were adm tted to the neurosurgery department. F ve (41.6%) of the pat ents adm tted to the neurosurgery department underwent surg cal ntervent on. Seven pat ents (10.9%) were adm tted to the departments other than neurosurgery due to add t onal njur es, wh le 2 of them (28.5%) requ red orthoped c surg cal treatment. Only 1 out of 64 pat ents was ex tus. (1.6%)

The s tes of the vertebral fractures are shown n [Table 1], [Table 2], [Table 3]. Cons der ng the fracture types, one pat ent had all three types of compress on, sp nous process, and burst fractures. Th s pat ent was ex tus. Other pat ents had only one type of

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13.10.2020 Analys s of ger atr c pat ents w th m nor sp nal trauma adm tted to the emergency department of a un vers ty hosp tal :Tufan Ak n G …

www.jadweb.org/pr ntart cle.asp? ssn=2221-6189;year=2019;volume=8; ssue=5;spage=191;epage=194;aulast=G ray 3/4 fracture. G ven the fracture types, 47 fractures (74.6%) were compress on, 14 fractures (22.2%) were sp nous process and 2 fractures (3.2%) were burst fractures. Twenty pat ents (31.2%) had mult level vertebral fractures.{Table 1}{Table 2}{Table 3}

4. D scuss on

Acc dental njur es are one of the lead ng causes of death n the ger atr c pat ent. Moreover, these njur es can result n mmob l ty, caus ng pat ents to become needy for home care[5]. In the study by van der Jagt-W llems et al., 66% of the pat ents were female. In l ne w th the l terature, 64.1% of the pat ents were female n our study[6]. Th s may be expla ned by more frequent nc dence of osteoporos s n females n the ger atr c age group[7].

In th s study, we a med to demonstrate the cl n cal character st cs of pat ents w th ger atr c vertebral fracture who were adm tted to an emergency department. Traumas were most common between people aged 75-84 years w th nc dence as 40.6%.

Cons der ng the mechan sm of njury, we found that about 80% of the pat ents were brought to the emergency department due to fall. Add t onal system c njur es were also common n th s age group. The most common add t onal system c njury was costal fracture. In ger atr c vertebral traumas, falls come to the fore as n our study. It has been reported that about 40% of pat ents fall at least once dur ng a year, and th s rate and fall-related compl cat ons are two t mes h gher over the age of 75 years[5]. In l ne w th the l terature, about 80% of traumas were caused by falls n our study. The most affected age group by traumas and assoc ated system c njur es was between 75-84 years. The frequent nc dence of falls n th s age group s attr buted to the fact that these pat ents have certa n r sk factors. For example, polypharmacy, decl ne n cogn t ve funct on, decreased da ly act v ty, v sual, balance and ga t d sturbances, as well as d seases such as muscle weakness, arthr t s and depress on are shown as major r sk factors for falls[8].

In the study by Tonbul et al., the 3 most common njured sp nal vertebrae were lumbar 1 (L1) (63.8%), thorac c 12 (T12) (12%) and lumbar 2 (L2) (10.6%)[9]. S m larly, our study found that trauma most commonly occurred n these three vertebrae (L1: 34.3%, T12: 17.2% and L2: 15.6%). It s stated that the reason why vertebral njury mostly occur n the thoracolumbar reg on s due to the absence of protect ve cage effect s nce the r bs end n th s reg on. In add t on, the progress on of lumbar lordos s to thorac c kyphos s n th s reg on s one of the factors that make the thorac c lumbar reg on vulnerable. The facet jo nts of the thorac c vertebrae are located n the coronal plane, wh le the sag ttal locat on of those of the lumbar vertebrae also causes facet jo nt d sor entat on, wh ch comes to the fore as another factor lead ng to ncreased fracture r sk[10].

The most common nternal organ njury due to vertebral fractures s reported to be caused by damage to the thorac c vertebrae[10]. In our study, the most common v sceral njury was pulmonary contus on assoc ated w th thorac c vertebral les on (4.7%). Hebert et al. reported that the most common concom tant njury w th vertebral njury was extrem ty trauma (26.5%)[11]. Whereas, n our study, t was costal fracture (9.4%). The d fference may be due to the fact that the most common cause of trauma was motor veh cle acc dent n the abovement oned study, wh le t was same-level fall n our study.

Armagan et al. reported that 36 out of 46 pat ents w th vertebral trauma were hosp tal zed. Of the pat ents, 23 (50%) were hosp tal zed by neurosurgery, wh le 13 (28.2%) were hosp tal zed by orthoped cs. N ne of the pat ents hosp tal zed n neurosurgery (69.2%) and 6 of the pat ents hosp tal zed n orthoped cs (46.1%) requ red surg cal treatment, wh le other pat ents rece ved conservat ve treatment[12]. In our study, surg cal treatment was performed on 5 pat ents (41.6%) by neurosurgery and on 2 pat ents (28.5%) by other departments.

In the study by Erturer et al., the most common type of fracture was compress on fracture w th 57%[10]. S m larly, compress on fracture was the most common type of fracture n our study (74.6%).

In conclus on, we determ ned 64 ger atr c cases of vertebral fractures n a 4-year per od n the emergency department of our hosp tal. Of the pat ents, 64.1% were female and the h ghest number of adm ss ons was n the age group of 75-84 years (40.6%). The most common fracture s tes were L1 and T12 (34.3% and 17.2%, respect vely). We found that the most common add t onal njury was costal fracture (9.4%). A total of 7 pat ents underwent surg cal treatment (10.9%). The results of our study demonstrated the mportance of vertebral fractures n the ger atr c age group. In th s age group, falls and motor veh cle acc dents are the lead ng causes of vertebral traumas. Necessary measures should be taken to prevent the r sk factors, then to decrease the mortal ty and morb d ty as a result of vertebral fracture.

Confl ct of nterest statement

The authors report no confl ct of nterest.

References

1 Polat O, Kabacam G, Guler I, Erg s K, Y ld z A. Surve llance analys s of the pat ents attended to Ibn S na Hosp tal Emergency Department. Turk J Emerg Med 2005; 5(2): 78-81.

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13.10.2020 Analys s of ger atr c pat ents w th m nor sp nal trauma adm tted to the emergency department of a un vers ty hosp tal :Tufan Ak n G …

www.jadweb.org/pr ntart cle.asp? ssn=2221-6189;year=2019;volume=8; ssue=5;spage=191;epage=194;aulast=G ray 4/4 2 Karadag B, Cat H, Ozturk AO, Basat O, Altuntas Y. Pat ents adm tted to emergency outpat ent cl n c and kept under

observat on: a survey of three years. Akad Ger atr 2010; 2: 176-185.

3 Akoglu H, Den zbas A, Unluer E, Guneysel O, Onur O. Demograph c character st cs of trauma pat ents of the emergency department of Marmara Un versty Hosp tal. Marmara Med J 2005; 18(3): 113-122.

4 Jacobs DG. Spec al cons derat ons n ger atr c njury. Curr Op n on Cr t Care 2003; 9: 535-539.

5 Rubenste n LZ. Falls n older people: ep dem ology, r sk factors and strateg es for prevent on. Age Age ng 2006; 35(S2): 37- 41.

6 van der Jagt-W llems HC, V s M, Tulner CR, van Campen JP, Woolf AD, van Munster BC, et al. Mortal ty and nc dent vertebral fractures after 3 years of follow-up among ger atr c pat ents. Osteoporos Int 2013; 24(5): 1713-1719.

7 Kan s JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, et al. The r sk and burden of vertebral fractures n Sweden. Osteoporos Int 2004; 15(1): 20-26.

8 Amer can Ger atr cs Soc ety, Br t sh Ger atr cs Soc ety, Amer can Academy of Orthopaed c Surgeons Panel on Falls Prevent on. Gu del ne for the prevent on of falls n older persons. J Am Ger atr Soc 2001; 49(5): 664-672.

9 Tonbul M, Y lmaz MR, Ozbaydar MU, Adas M, Altan E. Long-term results of conservat ve treatment for thoracolumbar compress on fractures. Acta Orthop Traumatol Turc 2008; 42(2): 80-83.

10 Erturer E, Tezer M, Ozturk I, Kuzgun U. Evaluat on of vertebral fractures and assoc ated njur es n adults. Acta Orthop Traumatol Turc 2005; 39(5): 387-390.

11 Hebert JS, Burnham RS. The effect of polytrauma n persons w th traumat c sp ne njury. Sp ne 2000; 25(1): 55-60. 12 Armagan E, Al G, Erdem M, Ozguc H, Tokyay R. W th vertebral and/ or sp nal njur es who were adm tted to f rst a d and

emergency room at med cal school of Uludag Un vers ty. Ulus Travma Ac l Cerrah Derg 2000; 6(2): 110-113.

Tuesday, October 13, 2020

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