Medico-Legal Evaluation of Geriatric Patients and Mortality Predictors in the Elderly with Forensic Trauma

Abstract

Objectives: The aim of this study was to investigate demographic and epidemiological aspects of older people with forensic events and to determine factors affecting in-hospital mortality in geriatric patients with forensic trauma. Materials and Methods: All patients aged ≥65 years who were admitted to the emergency department between January 1, 2015 and January 1, 2018 and reported as a forensic case were included in the study. The demographic data, vital and clinical findings, forensic diagnoses and in-hospital mortality statuses of the patients were recorded. ‘Glasgow Coma Scale’ for all patients and ‘Injury Severity Score’ for patients with forensic trauma were calculated. Characteristics of patients with in-hospital mortality and surviving patients were compared. Also, a multivariate logistic regression analyses was used to assess the predictors for in-hospital mortality in patients with forensic trauma. Results: A total of 598 geriatric forensic patients were included in the analyses. The most frequent forensic admission reason was motor vehicle collisions (n=317, 53.01%). 3.17% (n=19) of the patients died. The multivariate logistic regression model was formed with age, gender, Injury Severity Score, presence of multitrauma, falling from height and ground level falls. Falling from height was found to be the most distinctive predictor for in-hospital mortality [odds ratio: 54.628], and as age increased, mortality increased as well. Conclusion: The most frequent forensic event in the older people was motor vehicle collisions. In forensic admissions, the trauma mechanism of falling from height clearly increases in-hospital mortality among the geriatric population.

Keywords

• Emergency department,forensic medicine,geriatrics,mortality,trauma

Geriatrik Hastaların Mediko-Legal Açıdan Değerlendirilmesi Ve Adli Travmalı Yaşlılarda Mortalite Prediktörleri

Öz

Amaç: Çalışmanın amacı acil servise başvuran geriatrik yaş grubu adli vakaların demografik ve epidemiyolojik açıdan irdelenmesi ve geriatrik adli travma olgularında hastane içi mortalite üzerine etki eden faktörlerin belirlenmesidir. Materyal ve Metot: Çalışmamıza, 1 Ocak 2015 ve 1 Ocak 2018 tarihleri arasında acil servise başvuran ve adli bildirim yapılan 65 yaş ve üzeri tüm hastalar dahil edildi. Hastaların demografik verileri, vital ve klinik bulguları, adli tanıları ve hastane-içi mortalite durumları kaydedildi. Çalışmadaki tüm hastalar için ‘Glaskow Koma Skoru’ ve adli travmalı hastalar için ek olarak ‘Yaralanma Ciddiyet Puanı’ hesaplandı. Mortal seyreden ve sağ kalan hastaların özellikleri karşılaştırıldı. Adli travmalı hastalarda hastane içi mortalite prediktörlerini değerlendirmek için çok değişkenli lojistik regresyon analizi kullanıldı. Bulgular: Çalışmaya toplam 598 geriatrik adli hasta alındı. En sık adli başvuru nedeni motorlu taşıt kazaları (n=317, %53,01) idi. Hastaların %3,17'si (n=19) öldü. Çok değişkenli lojistik regresyon modeli yaş, cinsiyet, ‘Yaralanma Ciddiyet Puanı’, multitravma varlığı, yüksekten düşme ve zemin seviyesinden düşme parametreleri ile oluşturuldu. Hastane içi mortaliteyi ön görmede yüksekten düşme en belirgin prediktör olarak bulunurken [OR: 54,628], yaş artıkça mortalite artmaktaydı. Sonuç: Çalışmamız sonuçlarına göre aktif sosyal hayata katılımı gün geçtikçe artan geriatrik yaş grubunun günümüzde en sık karşılaştığı adli olay motorlu taşıt kazalarıdır. Ayrıca, adli başvurularda, özellikle yüksekten düşme travma mekanizması geriatrik populasyonda hastane içi mortaliteyi belirgin şekilde arttırmaktadır.

Anahtar Kelimeler

• Acil servis,adli tıp,geriatri,mortalite,travma

References

1. Steverson M. Ageing and health. World Health Organization, Fact Sheets. 2018, pp 1-7. Available from URL: http://www.who.int/news-room/fact-sheets/detail/ageing-and-health. (Access Date: 10.09.2018).
2. Kandiş H, Karakuş A, Katırcı Y, Karapolat S, Kara İH. Geriatric population and forensic traumas. Turk J Geriatr 2011;14(3):193-8.
3. Mert E. Use of emergency departments by elderly patients. Turk J Geriatr 2006;9(2):70-4.
4. Hruska K, Ruge T. The tragically hip: trauma in elderly patients. Emerg Med Clin North Am 2018;36(1):219-35.
5. Cavlak M, Akçan R, Tümer AR, et al. Forensic medicine evaluation of alzheimer patients: a series from Ankara, Turkey. Turk J Med Sci 2015;45(5):1047-50.
6. Bonne S, Schuerer DJ. Trauma in the older adult: epidemiology and evolving geriatric trauma principles. Clin Geriatr Med 2013;29(1):137-50.
7. Frazao SL, Silva MS, Norton P, Magalhaes T. Domestic violence against elderly with disability. J Forensic Leg Med 2014;28:19-24.
8. Gokcelli DK, Tasar PT, Akcam NO, et al. Evaluation of attempted older adults suicides admitted to a university hospital emergency department: Izmir study. Asian J Psychiatr 2017;30:196-9.

9. Reske-Nielsen C, Medzon R. Geriatric trauma. Emerg Med Clin North Am 2016;34(3):483-500.
10. Bilgin NG, Mert E. The characteristics of geriatric forensic cases. Turk J Geriatr 2005;8(1):13-16.
11. Hilal A, Akçan R, Eren A, Turhan A, Arslan M. Forensic geriatric deaths in Adana, Turkey. Arch Gerontol Geriatr 2010;50(3):9-12.
12. Kelsey JL, Procter-Gray E, Hannan MT, Li W. Heterogeneity of falls among older adults: implications for public health prevention. Am J Public Health 2012;102(11):2149-56.
13. Ferrera PC, Bartfield JM, D'Andrea CC. Outcomes of admitted geriatric trauma victims. Am J Emerg Med 2000;18(5):575-80.
14. Pudelek B. Geriatric trauma: special needs for a special population. AACN Clin Issues 2002;13(1):61-72.
15. Byard RW, Hanson KA, Gilbert JD. Suicide methods in the elderly in South Australia 1981-2000. J Clin Forensic Med 2004;11(2):71-4.
16. Akıncı E, Akıllı NB, Koylu R, Cander B. A retrospective evaluation of the patients over 65 years old who treated in toxicology intensive care unit because of unintentional or suicidal poisoning. Turk J Geriatr 2013;16(3):330-4.
17. Adams SD, Holcomb JB. Geriatric trauma. Curr Opin Crit Care 2015;21(6):520-6.
18. Hashmi A, Ibrahim-Zada I, Rhee P, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg 2014;76(3):894-901.
19. Braun BJ, Holstein J, Fritz T, et al. Polytrauma in the elderly: a review. EFORT Open Rev 2017;1(5):146-51.
20. Giannoudis PV, Harwood PJ, Court-Brown C, Pape HC. Severe and multiple trauma in older patients; incidence and mortality. Injury 2009;40(4):362-7.
21. Cevik Y, Doğan NÖ, Daş M, et al. Evaluation of geriatric patients with trauma scores after motor vehicle trauma. Am J Emerg Med 2013;31(10):1453-6.
22. Hollis S, Lecky F, Yates DW, Woodford M. The effect of pre-existing medical conditions and age on mortality after injury. J Trauma 2006;61(5):1255-60.
23. Clement ND, Tennant C, Muwanga C. Polytrauma in the elderly: predictors of the cause and time of death. Scand J Trauma Resusc Emerg Med 2010;18:26.