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Review: Prehospital factors associated with severe injury in older adults

机译：评论：与老年人严重伤害相关的院前因素

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Introduction: Globally, injury is amongst the leading causes of death and disability in all age groups. Despite the use of prehospital trauma triage guidelines, identification of older persons with severe, potentially life-threatening injuries has been problematic. The purpose of this paper is to review prehospital factors associated with severe injuries amongst older adults. Search strategy: MEDLINE, CINAHL, Embase, and Cochrane databases were searched using key word searches of natural language and MeSH vocabulary. Criteria for final retention of the articles included: a focus on adults 50 years and older, single or multisystem injury and identification of prehospital (injury scene) factors associated with severe injury. Severe injury was defined as a maximum Abbreviated Injury Score (MAIS) >= 3 or an injury severity score >= 16, including fatal injury. Results: The database searches yielded 469 unduplicated citations. Snowball searching yielded an additional 17 citations. Of these 486 citations, 19 research studies and 2 reviews with practice guidelines met the retention criteria. All of the research studies were secondary analyses, involving the use of hospital trauma registries, injury databases, patient medical records, and statewide hospital discharge data. These studies were conducted in the United States (US), Canada, and the United Kingdom (UK). Factors associated with severe injury included age, sex, systolic blood pressure, pulse, Glasgow Coma Scale (GCS) score, use of anticoagulant and antiplatelet agents, angle of impact, restraint systems, occupant mobility at the scene, and number of persons injured. Discussion and conclusions: The literature has two significant limitations: the lack of prospective studies of older trauma patient triage indicators and a lack of clarity in many published discussions related to the cause of injury mortality, i.e., whether deaths resulted from the direct effects of the injury or from complications, the effect of comorbidities, or a combination of these. The strongest evidence available at this time consists of retrospective analyses. There might be additional unidentified prehospital factors associated with severe injury in this population that have greater sensitivity, specificity, and predictive validity than current indicators. Seeking and validating such factors and validating existing triage indicators must assume priority amongst investigators and funding agencies.
机译：简介：在全球范围内，伤害是所有年龄段死亡和残疾的主要原因之一。尽管使用了院前创伤分诊指南，但对患有严重，可能威胁生命的伤害的老年人进行识别仍然存在问题。本文的目的是回顾与老年人严重伤害相关的院前因素。搜索策略：使用自然语言和MeSH词汇的关键字搜索来搜索MEDLINE，CINAHL，Embase和Cochrane数据库。文章最终保留的标准包括：重点关注50岁及以上的成年人，单系统或多系统损伤以及与严重损伤相关的院前（损伤现场）因素的识别。严重伤害定义为最高严重伤害评分（MAIS）> = 3或伤害严重程度评分> = 16，包括致命伤害。结果：数据库搜索产生了469个重复引用。雪球搜索又产生了17条引用。在这486次引用中，有19项研究和2篇具有实践指南的评论均符合保留标准。所有的研究都是次要分析，涉及医院创伤登记，伤害数据库，患者病历和全州医院出院数据的使用。这些研究在美国（US），加拿大和英国（UK）进行。与严重伤害相关的因素包括年龄，性别，收缩压，脉搏，格拉斯哥昏迷评分（GCS）评分，抗凝药和抗血小板药的使用，撞击角度，约束系统，现场乘员的活动性以及受伤人数。讨论与结论：文献有两个重大局限性：缺乏对较年长的创伤患者分类指标的前瞻性研究，以及在许多与伤亡原因相关的已发表讨论中缺乏明确性，即死亡是否是由创伤直接导致的。伤害或并发症，合并症的影响或这些因素的组合。目前最有力的证据包括回顾性分析。与目前的指标相比，该人群中可能还有其他与严重伤害有关的院前因素，它们具有更高的敏感性，特异性和可预测性。在调查人员和资助机构中，必须优先考虑寻求和验证此类因素并验证现有的分类指​​标。

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