Publications (2)0 Total impact
Article: Venous thromboembolism in the elderly: the result of comorbid conditions or a consequence of injury?[show abstract] [hide abstract]
ABSTRACT: Venous thromboembolism (VTE) is a common complication in trauma patients. Several risk factors have been identified that may place patients at in increased risk for VTE including preexisting medical conditions, iatrogenic factors, and injury-related factors. Advanced age has also been implicated as a risk factor for VTE. The purpose of this study was to determine the incidence and outcomes of VTE in geriatric trauma patients as well as to identify risk factors for VTE in this population. We performed a 10-year retrospective review of all trauma patients aged 65 years or older discharged with a diagnosis of VTE. Demographic data, injuries, mechanism, Injury Severity Score, Abbreviated Injury Score, Glasgow Coma Scale, length of stay, and mortality were collected. : Of 2,521 trauma patients aged 65 years or older, 82 (3.2%) were diagnosed with VTE. Seventy-two of 82 patients were diagnosed with deep vein thrombosis, and pulmonary embolism was found in 8 patients. Two patients had both a deep vein thrombosis and pulmonary embolism. Independent predictors of VTE included traumatic brain injury (p < 0.05); chest Abbreviated Injury Score ≥ 3 (p < 0.001); mechanical ventilation (p < 0.001); major operation (p < 0.001); and history of VTE (p = 0.05). Other comorbid conditions were not significantly associated with VTE. Preinjury anticoagulation had a trend toward a protective effect. Although length of stay was longer in patients with VTE (adjusted mean difference 14.7 days, p < 0.001), mortality for patients with and without VTE was 8.5% and 7.0%, respectively (p = 0.59). VTE is associated with prolonged length of stay and duration of mechanical ventilation as well as continued medical dependence after discharge. Several risk factors place the elderly trauma patient at an increased risk for VTE, and trauma or injury-related risk factors seem to have a greater impact on the development of VTE in comparison to underlying conditions or increasing patient age (>65 years). II, prognostic study.The journal of trauma and acute care surgery. 05/2012; 72(5):1286-91.
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ABSTRACT: Despite improvements in the diagnosis and management of acute kidney injury (AKI), posttraumatic renal dysfunction continues to be associated with increased morbidity and mortality. Intravenous (IV) contrast is known to induce AKI in high-risk groups including the elderly and critically ill. We sought to determine whether IV contrast exposure among high-risk trauma patients resulted in renal dysfunction as defined by the Acute Kidney Injury Network criteria. We performed a 3-year retrospective analysis of all patients admitted to our Level I trauma center surgical intensive care unit for >48 hours. Patients with preexisting chronic renal dysfunction were excluded. We performed univariate and bivariate analyses to identify risk factors for AKI. Multivariable logistic regression analysis identified independent predictors for AKI. Subgroup analysis was undertaken among high-risk groups to include elderly patients (aged ≥65 years) with admission hypotension (systolic blood pressure <90 mm Hg) and an Injury Severity Score (ISS) ≥25. Of the 6,317 patients, 571 (9.0%) patients met the inclusion criteria; 170 (29.8%) patients developed AKI. Age ≥65 years (odds ratio [OR] 2.26, 95% confidence interval [CI] = 1.06-4.80, p <0.034) and ISS ≥25 (OR 1.86, 95% CI = 1.12-3.07, p <0.015) were determined to be independent predictors of AKI. IV contrast was not identified to be a predictor of AKI. Upon subgroup analysis, IV contrast exposure was not a predictor of AKI among the elderly, hypotensive, or severely injured patients (ISS ≥25). A complete trauma workup including studies requiring IV contrast exposure should be considered safe even among high-risk trauma patients.The journal of trauma and acute care surgery. 01/2012; 72(1):61-6; discussion 66-7.
University of California, San Diego
San Diego, CA, USA
- Department of Surgery