Profile of fatal geriatric trauma at a Level 1 trauma centre of India

Sanjeev Lalwani; Purva Mathur; Mahesh Kumar; Chhavi Sawhney; Deepak Agrawal; Omika Katoch

doi:10.4103/jpsic.jpsic_8_18

ORIGINAL ARTICLE

Year : 2018 | Volume : 6 | Issue : 2 | Page : 51-53

Profile of fatal geriatric trauma at a Level 1 trauma centre of India

Sanjeev Lalwani¹, Purva Mathur², Mahesh Kumar³, Chhavi Sawhney⁴, Deepak Agrawal⁵, Omika Katoch²
¹ Department of Forensic Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
² Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
³ Department of Forensic Medicine and Toxicology, Rama Medical College Hospital and Research Centre, Hapur, Uttar Pradesh, India
⁴ Department of Anesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
⁵ Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication

10-Jan-2019

Correspondence Address:
Dr. Purva Mathur
Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi - 110 029
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jpsic.jpsic_8_18

Abstract

Background: Trauma in old age is a serious health issue and associated with high fatality. This study details the profile of fatal geriatric trauma at a Level 1 Indian trauma centre.
Methods: This is a retrospective study. A total of 779 geriatric patients were admitted to the Jai Prakash Narayan Apex Trauma Centre during 2-year period from January 2014 to December 2015. A retrospective analysis was done of all 194 fatal geriatric trauma patients who underwent autopsy at our centre during this 2-year period. The study has been taken ethical clearance from the institutional review board.
Setting: This study was conducted in a 165-bedded Level 1 trauma centre of India.
Participants: Hundred and ninety-four fatal geriatric trauma patients were included in the study.
Interventions: There were no interventions in this study.
Measurements: Data were represented in median (range: minimum–maximum) and frequency (%).
Results: The duration of admission of these 194 patients ranged from <1 to 91 days (median 3 days). The causes of trauma were road traffic accidents in 78 (40%), fall from height in 75 (39%), assault in 12 (6%), railway accident in 10 (5%) and unconsciousness in 10 (5%). The autopsy-proven primary cause of death was severe head injury in 89 (46%), septicaemia in 30 (15%), polytrauma in 11 (6%), orthotrauma in 12 (6%), haemorrhagic shock in 9 (5%), spinal injury in 8 (4%), musculoskeletal injury in 3 (2%) and fat embolism in 3 (2%).
Conclusion: In our study, while most of the early deaths were due to severe head injuries, late deaths were predominantly due to infections.

Keywords: Fatal, geriatric, infections, neurotrauma

How to cite this article:
Lalwani S, Mathur P, Kumar M, Sawhney C, Agrawal D, Katoch O. Profile of fatal geriatric trauma at a Level 1 trauma centre of India. J Patient Saf Infect Control 2018;6:51-3

How to cite this URL:
Lalwani S, Mathur P, Kumar M, Sawhney C, Agrawal D, Katoch O. Profile of fatal geriatric trauma at a Level 1 trauma centre of India. J Patient Saf Infect Control [serial online] 2018 [cited 2023 Mar 30];6:51-3. Available from: https://www.jpsiconline.com/text.asp?2018/6/2/51/249845

Introduction

Globally, trauma is currently the fifth leading cause of death. The most lethal trauma is the traumatic brain injury, coined as the 'silent epidemic' by the Centres for Disease Control (CDC).^[1] A neglected and understudied group in this silent epidemic is the geriatric population. With a rapidly growing elderly population in the world,^[2] it is essential to understand the epidemiology and causes of mortality in this vulnerable trauma population.

This study was conducted at the Jai Prakash Narayan Apex (JPNA) Trauma Centre of the All India Institute of Medical Sciences, New Delhi, which is a 2500-bedded referral hospital of India. The trauma centre is a 165-bedded, multispecialty referral centre, with a neurotrauma and polytrauma Intensive Care Units, step-down facilities and wards.

Methods

A total of 779 geriatric patients were admitted to the JPNA Trauma Centre during 2-year period from January 2014 to December 2015. A retrospective analysis was done of all 194 fatal geriatric trauma patients who underwent autopsy at our centre during this 2-year period. The parameters that were recorded included epidemiological features, type of trauma, duration of hospital stay, cause of death and microbiological data.

Results

The duration of admission of these 194 patients ranged from <1 to 91 days (median 3 days). A total of 62 (32%) patients were admitted for <1 day. The total duration of admission of these 194 patients amounted to 2003 days. The age of the patients ranged from 65 to 97 years (median 65 years); there were 147 (76%) males and 47 (24%) females.

The causes of trauma were road traffic accidents in 78 (40%), fall from height in 75 (39%), assault in 12 (6%), railway accident in 10 (5%) and falling unconsciousness in 10 (5%). The autopsy-proven primary cause of death was severe head injury in 89 (46%), septicaemia in 30 (15%), polytrauma in 11 (6%), orthotrauma in 12 (6%), haemorrhagic shock in 9 (5%), spinal injury in 8 (4%), musculoskeletal injury in 3 (2%) and fat embolism in 3 (2%).

No samples for microbiological culture were received from 119 patients. This included the 62 patients who had a stay of <1 day at the centre. From the remaining patients, a total of 977 ante-mortem samples were received for culture. Of the 977 samples, 385 (39%) were blood, 173 (18%) were tracheal aspirate, 130 (13%) were urine, 97 (10%) were bronchoalveolar lavage (BAL), 83 (9%) were pus/tissue/wound aspirate, 29 (3%) were central line tips, 40 (4%) were cerebrospinal fluid (CSF), 2 (0.20%) were intercostal drain fluid, 31 (3.2%) were peritoneal fluid and 7 (0.72%) were pleural fluid. Of these, 80 of 385 blood samples (21%), 47 of 173 tracheal aspirates (27%), 51 of 97 BAL aspirates (53%), 42 of 83 pus/tissue samples (51%), 12 of 130 urine samples (9%), 5 of 40 CSFs (13%), 12 of 31 peritoneal fluids (39%), 1 of 7 pleural fluids (14%) and 3 of 29 central line tips were culture positive (10%).

Of the 277 organisms recovered from these 253 culture-positive samples, Acinetobacter baumannii (98; 35%) was the most common isolate, followed by Pseudomonas aeruginosa (41; 15%), Escherichia ^{More Details} coli (39; 14%), Klebsiella pneumoniae (29; 10%), Burkholderia cepacia (28; 10%), Candida spp. (10; 4%), Acinetobacter lwoffii (7; 3%), Staphylococcus aureus(7; 3%), Providencia spp.(5; 2%), Enterococcus faecalis (4;1%), Stenotrophomonas maltophilia (2; 0.7%), Staphylococcus haemolyticus (2; 0.7%), Pseudomonas putida (2; 0.7%), Enterobacter cloacae (1; 0.4%), Staphylococcus epidermidis (1; 0.4%) and Salmonella ^{More Details} typhi (1; 0.4%).

Discussion

In our study, most of the early deaths were due to severe head injuries, similar result has been reported in other studies,^{[3],[4],[5],[6],[7]} and late deaths were predominantly due to infections; pneumonia and bloodstream infection (BSI) secondary to pneumonia being the most frequent among them. The data were obtained from the indigenous healthcare-associated infections surveillance system in which all infections are defined as per the CDC's criteria.^[8],[9],[10] Most of the severely injured patients are put on life-saving devices such as central line, ventilators and urinary catheters. Trauma patients, especially the geriatric subgroup, are highly prone to pneumonia due to ventilation and aspiration. Prolonged central line and urinary catheter insertion also predispose these patients to BSIs and urinary tract infections (UTIs), respectively.^[7],[11] We have observed more than 50% culture positivity in BAL samples (53%) and pus/tissue samples (51%) followed by that of tracheal aspirate (27%) and blood (21%). Gram-negative pathogens were most common isolates causing sepsis as observed from other studies in the literature.^[5] Among the Gram-negative pathogens, A. baumannii (98%) was most common organism, while S. aureus (3%) was the most common among Gram-positive pathogens. Therefore, adopting measures such as preventive bundles for ventilator-associated pneumonia, BSIs and UTIs can significantly reduce the morbidity and mortality in this patient population. Studies conducted in different centres showed positive correlation of surveillance measure and decline in nosocomial infections. Data from these institutes including our centre suggest that the implementation of such bundles can reduce infection rates.^{[12],[13],[14],[15]} However, due to the retrospective nature of this study, we could not assess the effects of hospital infection control measures which were taken for this geriatric population. As suggested by Chehade et al.,^[16] introduction of 'Geriatric Emergency Departments' will facilitate increased involvement of geriatricians in trauma care and help in training other health disciplines in the basic principles of geriatric assessment and management.

Conclusion

RTA still accounts for the majority of elderly trauma in India, in contrast to falls, which predominate in the Western world.^[1],[2],[16] This requires a system change and public awareness in developing countries, with emphasis on wearing helmets and seat belts.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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