Trauma admissions in the elderly: how does a patient''s age affect the likelihood of their being admitted to hospital after a fracture?

In two projects we have studied patients presenting to Accident and Emergency (A&E) departments with a fracture, to examine how their age influences their likelihood of admission. Over 1 year from April 1994 we collected data on all 6467 Cardiff residents who presented to the city's A&E department with a fracture. In total 1226 (19%) were admitted. Overall, only 12% of those under 65, but 47% of older patients required admission. This was largely a reflection of the age-distribution of hip fracture, an injury for which admission is inevitable. In a subsequent study of eight A&E departments in South Wales we therefore considered the proportion of patients admitted following fractures at specific anatomical sites. In people over the age of 55 we identified 6889 fractures, 2115 (31%) of which led to admission. After standardisation to control for the age-distribution of incidence for different fracture sites, we found that the likelihood of admission was 22% greater for people aged over 65 years. Elderly people very often require hospital admission after a fracture, primarily as a consequence of the types of fractures that they tend to sustain. Admissions directly attributable to the effects of age and age-related medical, psychiatric and social comorbidity appear of more limited significance.     

Dental radiography: efficacy in the assessment of intraosseous lesions of the face and jaws in asymptomatic patients

In this investigation the efficacy of dental radiography for the detection of occult intraosseous lesions of the face and jaws was evaluated. An analysis of 30 million health insurance records indicated that the period prevalence of malignant lesions was less than 5 cases/million/year, and for benign lesions approximately 100 cases/million/year. Data from a controlled observer-performance study showed that radiographic sensitivities ranged between 50% and 80%. The cost per true-positive finding was estimated to be +8.6 million per malignant case and +430,000 per benign case. An assessment of the dosimetric literature indicated that the benefits of radiographic screening as a means for early detection of a malignancy appear to be counterbalanced by the risk of causing a radiation-induced malignancy. Taken together, these data demonstrate that dental radiography is not efficacious for the purpose of detecting occult lesions.     

Stenoses in dialysis fistulas: treatment with percutaneous angioplasty

Percutaneous transluminal angioplasty (PTA) was performed on 30 stenotic lesions in 25 dialysis access fistulas. The fistulas were in 23 patients with a mean age of 53 years. Lesions were detected with angiography within a few days after poor flow or increased venous pressure was documented during dialysis. Twenty-two lesions were in patients with polytetrafluoroethylene graft fistulas, five were in patients with bovine carotid fistulas, and three were in patients with endogenous arteriovenous fistulas. There were 28 venous stenoses (20 at the anastomotic site and eight more proximally) and two arterial stenoses. The overall success rate was 80%, with a 6-month patency of 76% and a mean patency after PTA of 9.4 months. Among the venous lesions, the success was 100% for proximal lesions and 71% for anastomotic lesions. There were two technical failures, which required surgery for revision of the fistulas, and four self-limited hematomas. PTA is a safe and effective treatment for stenoses in dialysis fistulas, particularly for lesions remote from the anastomotic sites.