• Ешқандай Нәтиже Табылған Жоқ

the complaint of falling was significantly higher in female patients than in male patients (p<0.05). Whereas rate of the patients who presented with the complaint of assault was significantly higher in male patients (p=0.000).

Type of trauma was found as blunt in 1987 (94.3%) and penetrating in 121 (5.7%) patients. The rate of exposing to blunt trauma (94.3, n=1987) was significantly higher in both genders compared to assault trauma (5.7, n=121) (p=0.000). The rates of sharp object injury (7.9%, n=77) and assault (4.1%, n=40) were significantly higher in the patients aged under 75 years than in the patients aged 75 years and over (p=0.000) (Table 3).

Table 3. Distribution of the patients according to scene, mechanism and type of trauma.

n %

Trauma scene

Home 823 39.0%

Street 1222 58.0%

Other 63 3.0%

Trauma mechanism

Falling 1810 85.9%

Motor vehicle accident 27 1.3%

Pedestrian struck 116 5.5%

Assault 56 2.7%

Sharp object injury 99 4.7%

Trauma type Blunt 1987 94.3%

Penetrating 121 5.7%

When vital findings at the time of admission were examined; body temperature was within the normal range in 99.4% (n=2094), and heart rate in 1908 (90.5%9 patients.

Bradycardia was found in 50 (2.4%) and tachycardia in 150 (7.1%) patients. Systolic blood pressure was between 90- 149 mmHg in 1622 (76.9%), ≥ 150 mmHg in 484 (23%) and

≤ 89 mmHg in 2 (0.1%) patients. Oxygen saturation was ≥ 90% in almost all patients. Again, respiratory rate and GCS scores were within normal range in almost all patients.

The body region exposed the trauma was found as extremities in 862 (40.9%), head & neck in 395 (18.7%), and thorax in 106 (5.0%) patients. Trauma was occurred in more than one body regions in 727 (34.5%) patients (Figure 4).

Figure 4. Distribution of the body regions exposed to trauma.

When outcomes of the patients were reviewed; 1772 (84.1%) patients were discharged directly from the emergency department, 10 (0.5%) patients were referred to an outer center, and 6 (0.3%) patients died. Of the patients, 219 (n=10.4%) were hospitalized in the

orthopedics clinic, and 35 (1.7%) in the neurosurgery clinic, while 6 (0.3%) patients were referred to the intensive care unit (Table 4). Majority (50.5%) of the discharged patients were aged between 65-74 years, while most (41.7%) patients who were referred to the intensive care unit or died were aged between 75-84 years. All of the patients who were referred to the intensive care unit or died (n=12) were bought with a 112 ambulance and traumas in these patients were caused by falling and pedestrian struck (n=6, respectively).

Table 4. Outcomes of the patients.

n %

Outcome

Discharged 1772 84.1%

Leaving without

permission 3 0.1%

Leaving with

permission 17 0.8%

Died 6 0.3%

Referred to

an outer center 10 0.5%

Clinic of Hospitalization

Orthopedics 219 10.4%

Neurosurgery 35 1.7%

Neurology 18 0.9%

Internalmedicine 10 0.5%

Intensivecare 6 0.3%

Others 12 0.6%

Discussion

Studies conducted about presentations of geriatric patients to emergency departments have been reported between 9% and 19% (9,14,16,23). In a study by Mert E.

(12), trauma accounted for 5% of geriatric emergency admission. This rate was found as 9.9% in a study by Dede F (7). In our study, we found that rate of geriatric traumas as 0.62% among all presentations, and 6.05% among all trauma presentations.

In a study by Özdoğan et al. (15) conducted in Hacettepe University on 318 patients with geriatric trauma, male/female ratio was found as 1:4, while Mert E. (12) reported this ratio as 1:2. Similarly, in our study also the number of female patients ws higher.

The mean age of geriatric patients was found as 76.6 in a study performed in Hacettepe University Medical Faculty, Emergency Department (7). Similarly, mean age of geriatric patients was found as 76.5 in a thesis study by Cesur (2). In our study, 977 (46.3%) patients were in 65-74 years age, 779 (37%) patients in 75-84 years age group, and 352 (16.7%) patients were in ≥ 85 years age group.

In the thesis study by Cesur, it was found that transfer with an ambulance was preferred more in geriatric patients (2). Unlike this study, 1324 (62.8%) presented as ambulatory, while 679 (32.2%) were brought to the emergency department with a 112 ambulance, and 105 (5.0%) with a private ambulance.

It is known that, 90% of the population aged over 65 years had at least one, 35% two, 23% three, and 15% four or more chronic health problems (4). Hypertension (HT) and chronic kidney failure (CKF) were found in 64.3%, diabetes mellitus (DM) in 13.1%, and osteoporosis (OP) in 15.5%

(18) of geriatric patients (10). Similarly, in a study by

Abdulhayoğlu evaluating geriatric patients, 95.82% of the patients had a history of at least one disease, and the most common first four underlying diseases were HT by 62.8%, CAD by 21.3%, DM by 20.3%, and OP by 15.2% (1). These rates were similar with a study conducted by Dede F. (14) in 2006. However, there were at least one chronic disease in 80.2%, two chronic diseases in 38.9% and three chronic diseases in 14.8% of the geriatric patients.

Type of trauma was blunt in 94.3% and penetrating in 5.7% of the patients. The rate of exposing to blunt trauma was significantly higher than penetrating trauma in both genders (p=0.000). This may be attributed to that, causes of geriatric trauma are rather due to fallings. Sharp object injury and assault rates were significantly higher in patients aged under 75 years compared to the patients aged 75 years and over (p=0.000). This may be explained by that, the rate of exposing to forensic trauma.

In the study by Abdulhayoğlu, 58% of trauma patients were using at least one, and 45.6% were using two or more drugs (1). In our study, 75.8% of the geriatric patients were using at least one drug, and 35.5% two or more drugs.

In the study by Cesur, rate of trauma exposure at street was higher. In addition, exposing to trauma at home was significantly higher in patients in the geriatric age group compared to the other patients (2). Whereas in our study, 58% of the geriatric patients were exposed to trauma at street and 39% at home.Majority of the patients who experienced trauma at home were aged 75 years and over.

The rate of being exposed to trauma at street was higher in patients aged under 75 years (p=0.000).

In our study, the rate of patients who presented due to falling was significantly higher in female than in male patients. Similarly, in a study conducted in the USA in 2006 the rate of female patients who presented due to falling was 70.2%, while this rate was 29.8% in male patients (11). This may be attributed to that women spends more time in the house.

In a study by Özdoğan et al. on forensic trauma cases;

causes of trauma were found as traffic accidents in 91.2%, fallings in 3.5%, and assault in 5.3% of the patients (15). In a study by Abdulhayoğlu, the first three causes of presentations due to geriatric trauma were found as falling by 81.2%, traffic accidents by 9%, and burn in 4.2% (1). In the present study, geriatric patients presented to the emergency department due to falling by 85.9%, motor vehicle accident by 1.3%, pedestrian struck by 5.5%, assault by 2.7%, and sharp object injury by 4.7%.

In previous study show that, majority of the patients were exposed to extremity and head traumas (2,3,6). In a study by Güneypete et al. in Uludağ University Medical Faculty in 2008, extremity trauma was found by 38.7% and head trauma by 35.3% (10). Similarly, in our study also the most common two body region exposed trauma were the extremities and head.

In our study, when outcomes of the patients were evaluated; 84.1% of the geriatric patients were discharged.

The most common two clinics of hospitalization were found as orthopedics and neurosurgery. There are similar studies in the literature (13). Majority of the discharger patients were in 65-74 years age range, while the patients who died or were referred to the intensive care units were in 75-84

years age range. This suggest that an advanced age is a risk factor for trauma cases.

Conclusion

Geriatric patient group is at a high risk for traumas. In case of presentation of geriatric patients to emergency departments, several characteristics of the cases such as patients’ comorbidities, drug use, socidemographic features, and trauma mechanism should be examined in details and the necessary attention should be paid. Further population based studies should be performed in order to prevent traumas in geriatric patients.

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Coresponding Author:

Cemil Kavalci, Asoc. Prof. Baskent University Faculty of Medicine, Emergency Department, Ankara. Turkey Рhоnе: +90 312 2036868

e-mail: cemkavalci@yahoo.com

Received: 7 February 2019 / Accepted: 27 May 2019 / Published online: 30 June 2019 UDC: 616-073.756.8-831.9

DIAGNOSTIC CAPABILITIES OF DIFFUSE-WEIGHTED MAGNETIC