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7 "Elderly"
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Original Article
Predicting 30-day mortality in severely injured elderly patients with trauma in Korea using machine learning algorithms: a retrospective study
Jonghee Han, Su Young Yoon, Junepill Seok, Jin Young Lee, Jin Suk Lee, Jin Bong Ye, Younghoon Sul, Se Heon Kim, Hong Rye Kim
J Trauma Inj. 2024;37(3):201-208.   Published online August 8, 2024
DOI: https://doi.org/10.20408/jti.2024.0024
  • 782 View
  • 24 Download
AbstractAbstract PDF
Purpose
The number of elderly patients with trauma is increasing; therefore, precise models are necessary to estimate the mortality risk of elderly patients with trauma for informed clinical decision-making. This study aimed to develop machine learning based predictive models that predict 30-day mortality in severely injured elderly patients with trauma and to compare the predictive performance of various machine learning models. Methods: This study targeted patients aged ≥65 years with an Injury Severity Score of ≥15 who visited the regional trauma center at Chungbuk National University Hospital between 2016 and 2022. Four machine learning models—logistic regression, decision tree, random forest, and eXtreme Gradient Boosting (XGBoost)—were developed to predict 30-day mortality. The models’ performance was compared using metrics such as area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, specificity, F1 score, as well as Shapley Additive Explanations (SHAP) values and learning curves. Results: The performance evaluation of the machine learning models for predicting mortality in severely injured elderly patients with trauma showed AUC values for logistic regression, decision tree, random forest, and XGBoost of 0.938, 0.863, 0.919, and 0.934, respectively. Among the four models, XGBoost demonstrated superior accuracy, precision, recall, specificity, and F1 score of 0.91, 0.72, 0.86, 0.92, and 0.78, respectively. Analysis of important features of XGBoost using SHAP revealed associations such as a high Glasgow Coma Scale negatively impacting mortality probability, while higher counts of transfused red blood cells were positively correlated with mortality probability. The learning curves indicated increased generalization and robustness as training examples increased. Conclusions: We showed that machine learning models, especially XGBoost, can be used to predict 30-day mortality in severely injured elderly patients with trauma. Prognostic tools utilizing these models are helpful for physicians to evaluate the risk of mortality in elderly patients with severe trauma.
Summary
Case Report
Positioning of Resuscitative Endovascular Balloon Occlusion of the Aorta Catheter: A Case of an Elderly Patient with Concomitant Chest and Pelvic Injury after Blunt Trauma
Dongsub Noh, Jeongseok Yun, Ye Rim Chang
J Trauma Inj. 2020;33(3):186-190.   Published online September 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0030
  • 3,851 View
  • 78 Download
AbstractAbstract PDF

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used in recent years as a resuscitative adjunct for trauma patients with life-threatening non-compressible torso hemorrhage. By blocking the aorta temporarily with an inflated balloon, REBOA preserves cerebral and coronary perfusion while diminishing exsanguination below the balloon, thereby providing time for resuscitation and definitive bleeding control. When determining the occlusion zone during the REBOA procedure, factors such tortuosity of the aorta, co-occurring minor chest injuries, and the severity of shock must be considered, as well as the main injury site. This paper describes a case of high Zone I REBOA in an elderly patient with a tortuous aorta who had concomitant injuries of the chest and pelvis.

Summary
Original Articles
Factors and Their Correlation with Injury Severity of Elderly Pedestrian Traffic Accidents
Tae gyu Hyun, Seok-Ran Yeom, Sung-Wook Park, Deasup Lee, Hyung bin Kim, Il Jae Wang, Byung Gwan Bae, Min keun Song, Youngmo Cho
J Trauma Inj. 2019;32(3):143-149.   Published online September 30, 2019
DOI: https://doi.org/10.20408/jti.2019.022
  • 3,723 View
  • 78 Download
AbstractAbstract PDF
Purpose

No previous study has assessed elderly pedestrian traffic accidents based on a nationwide database. This study aimed to help primary physicians who examine patients in emergency departments to determine and make prompt and accurate treatment decisions.

Methods

This study used data from the Emergency Department-based Injury In-depth Surveillance from 2013 to 2017, managed by the Korea Centers for Disease Control and Prevention. Pedestrians aged ≥65 years were included, and using multivariate logistic regression multiple factors were analyzed to determine their relationship with injury severity.

Results

Of 227,695 subjects, 6,498 were included, of whom 2,065 (31.8%) were severely injured. There were more female than male patients in all severity groups. Most accidents occurred in the afternoon and on general roads. In the multivariate analysis, the odds ratio (OR) of injury severity for male pedestrians was 1.165 (95% confidence interval: 1.034?1.313, p=0.012). Older age of patients and the use of ambulances were associated with greater injury severity. The accident time affected the degree of injury severity; i.e., compared to dawn, injury severity increased in the morning (OR: 1.246, p=0.047) and decreased at night (OR: 0.678, p<0.001). A significant difference was noted in the correlation between the type of vehicle causing the accident and the accident severity; i.e., motorcycle accidents had lower severity than bicycle accidents (OR: 0.582, p=0.047).

Conclusions

Injury severity was correlated with sex, age, transportation to the ED, TA onset time, and type of vehicle. The study results suggest that injury severity may be positively reflected in initial assessments and overall integrated treatments by physicians and in the related policies.

Summary
Epidemiological and Clinical Characteristics of Elderly Fall Patients Visit to the Emergency Department: A Comparison by Gender
Jun Kew Kim, Sun Pyo Kim, Sun Hyu Kim, Gyu Chong Cho, Min Joung Kim, Ji Sook Lee, Chul Han
J Trauma Inj. 2018;31(3):117-124.   Published online December 31, 2018
DOI: https://doi.org/10.20408/jti.2018.025
  • 3,487 View
  • 57 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

This study was to analyze clinical and epidemiological characteristics of elderly patients who were admitted to the emergency department (ED) due to falls by separating male and female.

Methods

We retrospectively analyzed the fall patients aged 65 years or older from the data of the in-depth surveillance study of injured patients visit to the ED under the supervision of the Korea Centers for Disease Control and Prevention (KCDC) from 2011 to 2016 by separating male and female.

Results

A total of 361,588 elderly fall patients were analyzed and, among them, 14,429 (37.3%) were males and 24,208 (62.7%) were females. Male and female showed similar frequency of damage happening season. However, they showed falling accident mostly on winter. The time of injury occurrence is mostly from 12:00 to 18:00 with 4,949 (34.3%) male and 8,564 (35.4%) female. Most falls occurred in daily activities, accounting for 7,614 (52.8%) in males and 14,957 (61.8%) in females, respectively. Unintentional damage accounted for the most part and 7,395 (51.2%) of male and 15,343 (63.4%) of female were injured indoors. Head and neck were the most common site of injuring, with 8,392 (58.2%) in males and 7,851 (32.4%) in females. According to ED examination outcomes, most of the patients were discharged, while the majority of the hospitalized patients were admitted to the general patient room.

Conclusions

The elderly falls occurred mostly from 12:00 to 18:00, during winter and to elderly women. Also, they happened unintentionally indoors in everyday life, mostly. Proved clinical, epidemiological characteristics from this research will be used as useful indicator at validity research of development of prevent program of falling accident for elderly people.

Summary

Citations

Citations to this article as recorded by  
  • The moderating role of social factors in the relationship between an incident of fall and depressive symptoms: a study with a national sample of older adults in South Korea
    Min-Kyoung Rhee, Yuri Jang, Soo Young Kim, Sujie Chang
    Aging & Mental Health.2021; 25(6): 1086.     CrossRef
Case Report
Bilateral Spontaneous Resolution of Chronic Subdural Hematoma: A Case Report
Gyeongung Seon, Ji Min Park, Ki Seong Eom
J Trauma Inj. 2015;28(1):43-46.   Published online March 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.1.43
  • 2,014 View
  • 15 Download
AbstractAbstract PDF
Although spontaneous resolution of chronic subdural hematoma (C-SDH) in the elderly has rarely been reported, spontaneous resolution of bilateral C-SDH is very rare. Here, we report the case of a 73-year-old female patient with no significant head trauma history who had a bilateral C-SDH spontaneously resolve despite receiving only conservative treatment. However, because of a lack of detailed knowledge about the mechanisms of resolution, treatment is often limited to surgical interventions that are generally successful, but invasive and prone to recurrence. We review the literature and discuss the possible relation of C-SDH's spontaneous resolution with its clinical and radiological characteristics.
Summary
Original Article
Clinical and Radiological Outcome of Distal Femoral Fracture in Elderly Patient Group
Hee Gon Park, Yeon Jun Kim, Ho Seong Jang
J Trauma Inj. 2013;26(4):286-290.
  • 996 View
  • 4 Download
AbstractAbstract PDF
PURPOSE
To report the postoperative Clinical and Radiological outcomes following distal femoral fractures in elderly patients compared with young patients.
METHODS
From March, 1996 to March, 2012, 83 patients who received surgical treatment for fractures of the distal femur were enrolled in this retrospective study. Ages more than 65 was named group A. Group A was 49 cases and mean age is 72.5 year(65~91year). Group B was 49 cases and mean age is 45.7 year(16~61 year). Surgical methods are retrograde IM nail, locking compression plate, cannulated screw and postoperative rehabilitation is no difference between two groups. Clinical results were evaluated using Neer scores, radiographic results and the presence of clinical complications.
RESULTS
The mean union period was 18.4(12-40) weeks in group A and 17(10-24) weeks in group B. Neer functional scores are no significant statistical difference between two groups. There are 5 cases metal breakage in group A and 1case in group B. There are 3 cases nonunion in group A and 1 case in group B.
CONCLUSION
In the case of fractures of the distal femur in elderly patients, locking plate using minimally invasive percutaneous periosteal osteosynthesis (MIPPO) technique may be one of the most effective methods and preoperative bone stock evaluation in important.
Summary
Case Report
The Use of Multiple Fenestrations of the Dura in Acute Traumatic Subdural Hematoma in Elderly
Jongtae Park, Jikwang Yun
J Trauma Inj. 2013;26(3):226-228.
  • 1,335 View
  • 7 Download
AbstractAbstract PDF
Elderly patients with acute subdural hematomas have higher mortality and lower functional recovery rates compared with those of other head-injured patients. Early and widely surgical decompression and active intensive care represent the best way to assist these patients. However, abrupt decompression of the hematoma can lead to brain disruption and secondary ischemia in the brain surrounding the craniectomy site. Acute brain swelling and brain extrusion, which take place shortly after decompression, can lead to a catastrophic situation during the operation due to the impossibility of appropriate closure of the dura and scalp. To avoid the deleterious consequences of disruption of brain tissue, we have adopted multiple fenestrations of the dura in a mesh-like fashion and gradual release of subdural clots through the small dural openings that are left open. This is especially important in cases in which there are massive amount of subdural hematomas with small parenchymal lesion and severe midline shifts in elderly patients. Further clinical experiences should be conducted in a more selected series patients to estimate the impact of this technique on morbidity and mortality rates.
Summary

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