The association of gender with mortality in trauma remains a subject of debate. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of gender with mortality in a group of geriatric trauma patients presenting to an academic level 1 trauma center (trauma center designated by New York State capable of handling the most severe injuries and most complex cases). Methods: We performed a retrospective review of geriatric trauma patients who were admitted to our trauma center between January 2018 and December 2020. Data collected included vital signs, demographics, injury, and clinical characteristics, laboratory data and outcome measures. The study controlled for co-morbidities, injury severity score (ISS), and systolic blood pressure (SBP) in the ED. Multivariable logistic regression analysis was performed to evaluate the association of gender and mortality. Results: 4432 geriatric patients were admitted during the study period, there were 1635 (36.9%) men and 3859 (87.2%) were White with an average age of 81 ± 8.5 years. The mean ISS was 6.7 ± 5.4 and average length of stay was 6 ± 6.3 days. There were 165 deaths. Male gender (OR 1.94, 95% CI 1.38 to 2.73), ISS (OR 1.12, 95% CI 1.09 to 1.14), Emergency Department SBP less than 90 mmHg (OR 6.17, 95% CI 3.17 to 12.01), and having more than one co-morbidity (OR 2.28, 95% CI 1.55 to 3.35) were independently predictive of death on multivariable logistic regression analysis. Conclusion: Male gender, Emergency Department systolic blood pressure less than 90 mmHg, having more than one co-morbidity, and injury severity are independent predictors of mortality among geriatric trauma patients.

Introduction: Preexisting anticoagulation is common among geriatric trauma patients. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of preexisting anticoagulation with mortality in a group of geriatric trauma patients. Methods: A retrospective review of geriatric trauma patients was conducted for those admitted to a Level 1 trauma center from January 2018 to December 2020. Vital signs, demographics, injury characteristics, laboratory data, and mortality were all collected. Multivariable logistic regression analysis was performed for the association of preexisting anticoagulation and a primary endpoint of all-cause mortality. These groups were controlled for preexisting comorbidities, injury severity scores, and systolic blood pressure in the emergency department. Results: Four thousand four hundred thirty-two geriatric patients were admitted during the study period. This cohort was made up of 36.9% men and 63.1% women. Three thousand eight hundred fifty-nine (87.2%) were white; the average age was 81±8.5 years, and the median injury severity score (ISS) was 5. The mean systolic blood pressure was 150±32 mmHg, mean heart rate was 81±16 bpm, mean lactate was 2.3±1.3, mean hematocrit was 37.3±8.8, and mean international normalized ratio (INR) was 1.7±10.3. One thousand five hundred ninety-two (35.9%) patients were on anticoagulation (AC) upon presentation. One hundred and sixty-five (3.7%) mortalities were recorded. Multivariable logistic regression analysis results show that preexisting anticoagulation [ odds ratio (OR) 1.92, 95% CI 1.36–2.72] was independently predictive of death. The analysis was adjusted for systolic BP in the emergency department less than90 mmHg (OR 5.55, 95% CI 2.83–10.9), having more than 1 comorbidity (OR 2.30, 95% CI 1.57–3.38) and ISS (OR 1.13, 95% CI 1.10–1.15). Conclusion: Our study indicates that preexisting anticoagulation is associated with mortality among geriatric trauma patients.

Background: In geriatric trauma patients, higher mortality rate is observed compared to younger patients. A significant portion of trauma sustained by this age group comes from low-energy mechanisms (fall from standing or sitting). We sought to investigate the outcome of these patients and identify factors associated with mortality. Methods: A retrospective review of 1285 geriatric trauma patients who came to our level 1 trauma center for trauma activation (hospital alert to mobilize surgical trauma service, emergency department trauma team, nursing, and ancillary staff for highest level of critical care) after sustaining low-energy blunt trauma over a 1-year period. IRB approval was obtained, data collected included demographics, vital signs, laboratory data, injuries sustained, length of stay and outcomes. Patients were divided into three age categories: 65–74, 75–84 and >85. Comorbidities collected included a history of chronic renal failure, COPD, Hypertension and Myocardial Infarction. Results: 1285 geriatric patients (age > 65 years) presented to our level 1 trauma center for trauma activation with a low-energy blunt trauma during the study period; 34.8% of the patients were men, 20.5% had at least one comorbidity, and 89.6% were white. Median LOS was 5 days; 37 (2.9%) patients died. Age of 85 and over (OR 3.44 with 95% CI 1.01–11.7 and 2.85 with 95% CI 1.0–6.76, when compared to 65–74 and 75–84, respectively), injury severity score (ISS) (OR 1.08, 95% CI 1.02 to 1.15) and the presence of more than one comorbidity (OR 2.68, 95% CI 1.26 to 5.68) were independently predictive of death on multi-variable logistic regression analysis. Conclusion: Age more than 85 years, higher injury severity score and the presence of more than one comorbidity are independent predictors of mortality among geriatric patients presenting with low-energy blunt trauma.

Geriatric trauma patients have worse outcomes compared to younger patients. Differences in trauma outcomes based on gender remain unproven. We sought to investigate the association of gender with outcomes among geriatric patients with traumatic brain injury (TBI) by performing a meta-analysis and review of the literature. A systematic review of published articles on outcomes of geriatric patients with TBI using PubMed was conducted. A total of 363 articles were identified, from these, 74 articles met the inclusion criteria of isolated TBI in geriatric patients. Upon review of the articles, only 5 met the specified criteria of the search which described male and female mortality amongst geriatric patients suffering isolated TBI. The data from these papers were combined into a master file and meta-analysis was performed using random-effect model with Rev Man 5.4 software. The total number of patients in these 5 papers was 23,893, of these 11,971 were men and 11,922 were women. The odds ratio for survival in these patients were 1.40, 2.40, 1.20, 1.28 and 1.15 with a combined final OR of 1.28 favoring women with a p value of less than 0.00001 and CI of 1.21-1.36. Female geriatric trauma patients sustaining TBI have better survival than men.

Total occlusion of the abdominal aorta is a rare and life-threatening event. Risk factors most commonly include coagulopathy, vasculitis, trauma, abdominal aortic aneurysms, aortic thromboembolism, and aortic dissection. The most common complications include severe ischemic manifestations in the lower extremities, spinal cord, or viscera. Thus, management is largely dependent on presumed etiology. We present a case of a morbidly obese 52-year-old female with a past medical history of hypertension, diabetes mellitus, peripheral vascular disease, and coronary artery disease with a smoking history of three packs per day for over 10 years. The patient first presented to our emergency department with bilateral lower extremity paresthesia and pain at rest. Further evaluation through computed tomography angiogram thus revealed infrarenal occlusion of the abdominal aorta and bilateral common iliac arteries; the patient was treated with an aorto-femoral bypass without further sequelae. Our case report details the associated risk factors of acute on chronic aortic occlusion and its management.