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Pressure sores and hip fractures
176
Abstract
sion and pulmonary embolism were of borderline statistical significance (p = 0.05). Our results suggest that both spinal and anaesthesia have similar outcomes. However, the sample is not controlled but does represent a cohort from everyday practice at a centre in the United Kingdom.
References 1 Rodgers A, et al. BMJ 2000;321:1493—7. 2 McKenzie PJ, Wishart HY, Dewar KMS, Gray J, Smith G. BJA 1980;52:49—53.
fixation were less likely to develop pressure sores in comparison to those fractures treated with a hemiarthroplasty or a sliding hip screw (2.0% versus 4.7% versus 4.4%). No relationship was seen related to length of surgery or type of anaesthesia. Our incidence of pressure sores is lower than previously reported (30%). Whilst determining factors that increase the risk of pressure sores may not be sufficiently reliable to be used for the individual patient, taking appropriate preventative measures can reduce the incidence, particularly with reference to (optimising the patient preoperatively and) reducing delays to surgery. Keywords: Hip fractures; Pressure sores; Decubitis ulcers
Keywords: Anaesthesia; Hip fractures; Mortality; Complications
doi:10.1016/j.injury.2007.11.338
doi:10.1016/j.injury.2007.11.337
[O49] Trauma in the elderly: Should the care of the elderly (COTE) physicians be part of the trauma team?
[O48] Pressure sores and hip fractures
N.D. Clement ∗ , C. Tennant, C. Muwanga
∗
S.K. Khan , R. Induluru, A.D. Pendse, S. Haleem, M.J. Parker Peterborough District Hospital, UK A neck of femur fracture is known to be a high risk factor for the development of pressure sores with an associated morbidity, mortality and cost. We have attempted to identify risk factors in these patients for the development of pressure sores by analysing prospectively collected data of 4654 consecutive patients (1003 males/3473 females). About 3.8% developed pressure sores in the sacral, buttock or heel areas. Patients factors that increased the risk of pressure sores were increased age (82.1 years versus 76.6 years), lower mental test score (4.65 versus 5.76), diabetes mellitus (pressure sore incidence 10.4%), higher ASA score (3.0 versus 2.7) and lower admission haemoglobin concentration (120 g versus 124 g). Those patients with an extracapsular fracture were more likely to develop pressure sores compared to patients with an intracapsular fracture (4.5% versus 3.1%). Being male was not a risk factor. While the time interval between fall and admission was not significant, the time interval between admission and surgery was found to be an extremely significant risk factor. A fall in blood pressure during surgery (5.6%) was found to increase risk. Patients who underwent a dynamic hip screw were more likely to develop pressure sores (incidence 4.7%). Patients with an intracapsular fracture treated with internal
Sunderland Royal Hospital, UK Increasing age and pre-existing medical conditions (PMCs) are independent risk factors associated with increased mortality after trauma. We are unaware of any published literature that identifies the actual cause of death in the elderly. To review all trauma deaths, identifying the cause and PMCs relating to age. A retrospective analysis of all trauma deaths over a 5-year period at Sunderland Royal Hospital (SRH) was conducted. Information was obtained from the Trauma Audit and Research Network (TARN) dataset, hospital records, post-mortem reports and death certificates. The time and cause of death, PMCs, injury severity score (ISS) were analysed for two age groups (<65 and ≥65 years). There were 56 trauma deaths: 24/462 (5.2%) were ≥65 years and 32/1458 (2.2%) were <65 years. SRH average annual mortality rate was 2.9% (TARN average was 5316/92084 [5.8%]). The time of death after admission and ISS for each age group is illustrated in Table 1. 33/56 (58.9%) patients, irrespective of age, with an ISS >15 died within the first 24 h from trauma causes. 13/56 (23.2%) patients with an ISS of <16 died after 13 days of medical conditions not directly related to their injuries. All 13 had PMCs, of which 9/13 (69.2%) were ≥65 years. Both pneumonia 5/13 (38.5%) and coronary heart disease 5/13 (38.5%) were the commonest causes of death.
Table 1 Age (year)
ISS
Patient deaths (% for age group) <2 days
2—13 days
>13 days
<65
1—15 16—24 >24
0 3 (9.4) 22 (68.7)
1 (3.1) 1 (3.1) 1 (3.1)
4 (12.5) 0 0
≥65
1—15 16—24 >24
1 (4.2) 1 (4.2) 6 (25)
3 (12.5) 0 2 (8.4)
9 (37.5) 1 (4.2) 1 (4.2)
Abstract
sion and pulmonary embolism were of borderline statistical significance (p = 0.05). Our results suggest that both spinal and anaesthesia have similar outcomes. However, the sample is not controlled but does represent a cohort from everyday practice at a centre in the United Kingdom.
References 1 Rodgers A, et al. BMJ 2000;321:1493—7. 2 McKenzie PJ, Wishart HY, Dewar KMS, Gray J, Smith G. BJA 1980;52:49—53.
fixation were less likely to develop pressure sores in comparison to those fractures treated with a hemiarthroplasty or a sliding hip screw (2.0% versus 4.7% versus 4.4%). No relationship was seen related to length of surgery or type of anaesthesia. Our incidence of pressure sores is lower than previously reported (30%). Whilst determining factors that increase the risk of pressure sores may not be sufficiently reliable to be used for the individual patient, taking appropriate preventative measures can reduce the incidence, particularly with reference to (optimising the patient preoperatively and) reducing delays to surgery. Keywords: Hip fractures; Pressure sores; Decubitis ulcers
Keywords: Anaesthesia; Hip fractures; Mortality; Complications
doi:10.1016/j.injury.2007.11.338
doi:10.1016/j.injury.2007.11.337
[O49] Trauma in the elderly: Should the care of the elderly (COTE) physicians be part of the trauma team?
[O48] Pressure sores and hip fractures
N.D. Clement ∗ , C. Tennant, C. Muwanga
∗
S.K. Khan , R. Induluru, A.D. Pendse, S. Haleem, M.J. Parker Peterborough District Hospital, UK A neck of femur fracture is known to be a high risk factor for the development of pressure sores with an associated morbidity, mortality and cost. We have attempted to identify risk factors in these patients for the development of pressure sores by analysing prospectively collected data of 4654 consecutive patients (1003 males/3473 females). About 3.8% developed pressure sores in the sacral, buttock or heel areas. Patients factors that increased the risk of pressure sores were increased age (82.1 years versus 76.6 years), lower mental test score (4.65 versus 5.76), diabetes mellitus (pressure sore incidence 10.4%), higher ASA score (3.0 versus 2.7) and lower admission haemoglobin concentration (120 g versus 124 g). Those patients with an extracapsular fracture were more likely to develop pressure sores compared to patients with an intracapsular fracture (4.5% versus 3.1%). Being male was not a risk factor. While the time interval between fall and admission was not significant, the time interval between admission and surgery was found to be an extremely significant risk factor. A fall in blood pressure during surgery (5.6%) was found to increase risk. Patients who underwent a dynamic hip screw were more likely to develop pressure sores (incidence 4.7%). Patients with an intracapsular fracture treated with internal
Sunderland Royal Hospital, UK Increasing age and pre-existing medical conditions (PMCs) are independent risk factors associated with increased mortality after trauma. We are unaware of any published literature that identifies the actual cause of death in the elderly. To review all trauma deaths, identifying the cause and PMCs relating to age. A retrospective analysis of all trauma deaths over a 5-year period at Sunderland Royal Hospital (SRH) was conducted. Information was obtained from the Trauma Audit and Research Network (TARN) dataset, hospital records, post-mortem reports and death certificates. The time and cause of death, PMCs, injury severity score (ISS) were analysed for two age groups (<65 and ≥65 years). There were 56 trauma deaths: 24/462 (5.2%) were ≥65 years and 32/1458 (2.2%) were <65 years. SRH average annual mortality rate was 2.9% (TARN average was 5316/92084 [5.8%]). The time of death after admission and ISS for each age group is illustrated in Table 1. 33/56 (58.9%) patients, irrespective of age, with an ISS >15 died within the first 24 h from trauma causes. 13/56 (23.2%) patients with an ISS of <16 died after 13 days of medical conditions not directly related to their injuries. All 13 had PMCs, of which 9/13 (69.2%) were ≥65 years. Both pneumonia 5/13 (38.5%) and coronary heart disease 5/13 (38.5%) were the commonest causes of death.
Table 1 Age (year)
ISS
Patient deaths (% for age group) <2 days
2—13 days
>13 days
<65
1—15 16—24 >24
0 3 (9.4) 22 (68.7)
1 (3.1) 1 (3.1) 1 (3.1)
4 (12.5) 0 0
≥65
1—15 16—24 >24
1 (4.2) 1 (4.2) 6 (25)
3 (12.5) 0 2 (8.4)
9 (37.5) 1 (4.2) 1 (4.2)