Comparison of Clinical Factors in Adult, Young Older,and Older Trauma Patients
Objective: To compare differences of clinical factors involving severity of injury (CRAMS), physiologic deterioration (MEWS), probability of survival (TRISS), length of stay (LOS) and in-hospital mortality rate among adult, young older and older traumatic injury patients.
Design: Retrospective comparative study
Methodology: The researcher recruited a total sample of 627 traumatic injury patients receiving care at emergency department (ED) concerning inclusion criteria. The data from medical records database of Tertiary hospital between 2015 and 2018 were gathered. The instruments for data collection composed of demographic and clinical data at ED visits record forms including severity of injury, physiologic deterioration and probability of survival. LOS and in-hospital mortality were also noted. A sample was divided into 3 groups regarding age; Group I: adult (18-54 years), Group II: young older (55-65 years), and Group III: older traumatic injury patients (over 65 years). Chisquare and Kruskal-Wallis test were employed for statistical analyses with level of signifcance at .05.
Results: The higher the age of a sample group increased, the more the female patients were reported. Overall analysis demonstrated that severity of injury (χ2 =22.76, p<.001), physiologic deterioration (χ2 =21.39, p<.001), probability of survival (χ2=311.83, p<.001) were statistically different among patients with different age groups. As for the analysis of patients having mechanism of injury as blunt injury in different age gropus, the finding revealed the differences among severity of injury (χ2 =18.00, p<.001), physiologic deterioration (χ2 =21.50, p<.001) and probability of survival (χ2 =244.40, p<.001). Additionally, among those with head injury in different age groups, the results indicated that only probability of survival (χ2 =60.00, p<.001) differed. Otherwise, ED LOS and inhospital mortality rate showed no differences (p>.05).
Recommendations: It can be concluded that the selected clinical factors in this study had different impacts on adult, young older and older traumatic injury patients visiting emergency department according to effects from aging adaptation.Therefore, ED nurses need to assess and prioritize which clinical factors should be managed concerning patient’s age, be sensitive for any alterations and monitor those physiologic parameters, specifcally, in older patients as to promote effective physiologic adaptation, maximize probability of survival, and minimize LOS and in-hospital mortality rate.
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