The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study
Introduction: This study compares outcomes between rural and urban geriatric trauma patients at a major trauma centre in South Africa. Materials and Methods: This retrospective cohort study from a prospectively entered data set, reviewed all patients aged 65 years or above admitted between January 2...
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| Format: | Article |
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Elsevier
2023-09-01
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| Series: | Surgery in Practice and Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266626202300030X |
| _version_ | 1797690223523528704 |
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| author | Bogo Lee Victor Kong Cynthia Cheung Nigel Rajaretnam John Bruce Vasel Manchev Robert Mills Damian Clarke |
| author_facet | Bogo Lee Victor Kong Cynthia Cheung Nigel Rajaretnam John Bruce Vasel Manchev Robert Mills Damian Clarke |
| author_sort | Bogo Lee |
| collection | DOAJ |
| description | Introduction: This study compares outcomes between rural and urban geriatric trauma patients at a major trauma centre in South Africa. Materials and Methods: This retrospective cohort study from a prospectively entered data set, reviewed all patients aged 65 years or above admitted between January 2013 to December 2020 to our trauma centre at Grey's Hospital, South Africa. Results: Over the 8-year study period, a total of 323 patients aged ≥ 65 years were included (201 males (62%), mean age: 72 years. Mechanism of injury: 257 blunt (80%), 52 penetrating (16%) and 14 others (4%). The median Injury Severity Score (ISS) was 9. The median Charlson Comorbidity Index (CCI) for all 323 cases was 3. The median length of hospital stay was two days. The overall mortality was 12%. The crude odds ratio (OR) for death in rural vs urban patients was 2.51 (95% CI 1.27 – 4.94). After propensity score stratification for ISS, heart rate (HR), respiratory rate (RR), Glasgow Coma Scale (GCS) and temperature, and adjustment for mechanism, operation, Intensive Care Unit (ICU) and need for mechanical ventilation, the risk of death among the rural patients remained higher than in urban patients at 2.46 times (p=0.063), however, it was not statistically significant. Those who were operated on were significantly less likely to die after adjustment for confounding factors. Admission to ICU and the need for mechanical ventilation were significantly associated with mortality. Conclusion: Rural geriatric trauma patients have worse outcomes than urban geriatric trauma even after adjustment for differences in demographic and injury profile. |
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| institution | Directory Open Access Journal |
| issn | 2666-2620 |
| language | English |
| last_indexed | 2024-03-12T01:56:27Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery in Practice and Science |
| spelling | doaj.art-b1a5ebc400c54aeb845e12fb4a323a262023-09-08T04:33:55ZengElsevierSurgery in Practice and Science2666-26202023-09-0114100184The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort studyBogo Lee0Victor Kong1Cynthia Cheung2Nigel Rajaretnam3John Bruce4Vasel Manchev5Robert Mills6Damian Clarke7Department of Surgery, University of Auckland, Auckland, New ZealandDepartment of Surgery, Auckland City Hospital, Auckland, New Zealand; Department of Surgery, University of KwaZulu Natal, Durban, South Africa; Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa; Corresponding author.Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa; Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South AfricaDepartment of Surgery, St James's Hospital, Dublin, IrelandDepartment of Surgery, University of KwaZulu Natal, Durban, South AfricaDepartment of Surgery, University of KwaZulu Natal, Durban, South AfricaDepartment of Surgery, Life Entabeni Hospital, Durban, South AfricaDepartment of Surgery, University of KwaZulu Natal, Durban, South Africa; Department of Surgery, University of the Witwatersrand, Johannesburg, South AfricaIntroduction: This study compares outcomes between rural and urban geriatric trauma patients at a major trauma centre in South Africa. Materials and Methods: This retrospective cohort study from a prospectively entered data set, reviewed all patients aged 65 years or above admitted between January 2013 to December 2020 to our trauma centre at Grey's Hospital, South Africa. Results: Over the 8-year study period, a total of 323 patients aged ≥ 65 years were included (201 males (62%), mean age: 72 years. Mechanism of injury: 257 blunt (80%), 52 penetrating (16%) and 14 others (4%). The median Injury Severity Score (ISS) was 9. The median Charlson Comorbidity Index (CCI) for all 323 cases was 3. The median length of hospital stay was two days. The overall mortality was 12%. The crude odds ratio (OR) for death in rural vs urban patients was 2.51 (95% CI 1.27 – 4.94). After propensity score stratification for ISS, heart rate (HR), respiratory rate (RR), Glasgow Coma Scale (GCS) and temperature, and adjustment for mechanism, operation, Intensive Care Unit (ICU) and need for mechanical ventilation, the risk of death among the rural patients remained higher than in urban patients at 2.46 times (p=0.063), however, it was not statistically significant. Those who were operated on were significantly less likely to die after adjustment for confounding factors. Admission to ICU and the need for mechanical ventilation were significantly associated with mortality. Conclusion: Rural geriatric trauma patients have worse outcomes than urban geriatric trauma even after adjustment for differences in demographic and injury profile.http://www.sciencedirect.com/science/article/pii/S266626202300030XTraumaGeriatricUrbanRural |
| spellingShingle | Bogo Lee Victor Kong Cynthia Cheung Nigel Rajaretnam John Bruce Vasel Manchev Robert Mills Damian Clarke The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study Surgery in Practice and Science Trauma Geriatric Urban Rural |
| title | The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study |
| title_full | The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study |
| title_fullStr | The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study |
| title_full_unstemmed | The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study |
| title_short | The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study |
| title_sort | association between rural or urban setting and outcomes in geriatric trauma patients in south africa a retrospective cohort study |
| topic | Trauma Geriatric Urban Rural |
| url | http://www.sciencedirect.com/science/article/pii/S266626202300030X |
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