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Doctoral Thesis
DOI
10.11606/T.22.2014.tde-21052014-162200
Document
Author
Full name
Ana Maria Ribeiro dos Santos
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2014
Supervisor
Committee
Rodrigues, Rosalina Aparecida Partezani (President)
Luz, Maria Helena Barros de Araújo
Marques, Sueli
Pavelqueires, Shirlene
Santos, Claudia Benedita dos
Title in Portuguese
Trauma por acidente de trânsito no idoso: fatores de risco e consequências
Keywords in Portuguese
Acidentes de Trânsito
Análise espacial
Ferimentos e lesões
Idoso
Risco relativo
Abstract in Portuguese
Atualmente a assistência à saúde do idoso é prioritária, verificando-se ser o envelhecimento um desafio mundial. Observa-se que a ocorrência de trauma tem aumentado nesta população nos últimos anos e os acidentes de trânsito são uma das causas mais frequentes destes eventos. O presente estudo é longitudinal retrospectivo com objetivo de analisar o trauma por acidente de trânsito no idoso atendido em um hospital municipal de referência em urgência nos anos de 2010 e 2011. O local de realização foi um hospital de urgência de referência e a Delegacia de Repressão aos Crimes de Trânsito. Em uma população de 524 idosos, os dados do estudo foram coletados por meio de levantamento nos prontuários, boletins de atendimento, boletins de registro de acidentes de trânsito e inquéritos policiais utilizando formulários validados por expertes na área do trauma. A análise descritiva foi realizada para todas as variáveis, incluindo as medidas de posição e de dispersão para as variáveis quantitativas. Na análise espacial utilizaram-se o Índice Local de Moran e a densidade de Kernel. Para análise do risco de acidente, trauma e óbito empregou-se como medida de associação o risco relativo. Do total de 524 idosos acidentados caracterizados pela média de 67,5 anos, 69,1% eram do sexo masculino, 66,9% eram casados e 65,3% possuíam ensino fundamental. Dentre os acidentados, 78,6% apresentaram trauma, sendo 34,9% pedestres e em 27,2% dos acidentes, a motocicleta foi o veículo envolvido. As lesões de maior incidência por região corporal ocorreram nos membros inferiores, correspondendo a 24,1%. Dentre as consequências, 47,7% foram imobilizações. As cirurgias ortopédicas responderam por 26,1% dos procedimentos. A alta hospitalar representou 83,2% da condição de saída do hospital. Dos acidentes, 92,5% ocorreram sem vítima fatal e 56,2% dos óbitos foram na faixa etária de 60 a 69 anos. Destes 59,7% eram pedestres, 47,3% ocorreram na sala de emergência, sendo 28,3% por traumatismo cranioencefálico. A análise espacial evidenciou que os óbitos se concentraram na área urbana, com aglomerado de bairros com alta ocorrência de acidente de trânsito, apresentando correlação positiva, assim como evidenciou também a existência de regiões com maior densidade de ocorrências. Os resultados do estudo demonstraram também forte associação entre o sexo masculino e a ocorrência de acidente, trauma e óbito em decorrência da lesão, em praticamente todas as situações e faixas etárias examinadas, principalmente entre os idosos mais velhos. Os acidentes de trânsito apresentaram características específicas nos idosos, carecendo de mais estudos para dimensionamento real do problema e adoção adequada de medidas de proteção cabíveis. Constatou-se a importância da análise espacial dos acidentes por local de ocorrência do evento, por possibilitar a identificação das regiões que necessitam, prioritariamente, da implantação e implementação de medidas preventivas e corretivas para prevenção e controle destas ocorrências
Title in English
Trauma by traffic accident in elderly people: risk factors and consequences
Keywords in English
Aged
Relative risk
Spatial analysis
Traffic accidents
Wounds and injuries
Abstract in English
Healthcare toward aged people is presently deemed to be a priority, as the aging process stands out as a world challenge. The occurrence of traumas has been increasingly observed in this population and traffic accidents are one of the most frequent sources of such events. The aim of the present longitudinal, retrospective study was to assess trauma by traffic accident in elderly people cared for at a municipal hospital, a reference in emergency health care services, in 2010 and 2011. The study was carried out at an emergency reference hospital and at a Transit Crime Repression Precinct. The study was composed of 524 aged people. Data were collected from medical records, emergency care reports, official traffic accident reports, and police reports with the application of forms validated by trauma experts. A descriptive analysis was carried out to all variables, including position and dispersion scales of measurement for all quantitative variables. The spatial analysis employed the Moran Local Statistics and the Kernel density estimate. The relative risk tool was used as a correlation measurement to assess accident risk, trauma and death. From the total amount of 524 injured elderly people, characterized by the mean of 67.5 years of age, 69.1% were men; 66.9% were married; and 65.3% had completed elementary school. Among the injured people, 78.6% presented trauma, being 34.9% pedestrians; in 27.2% of the accidents, the motorcycle was the type of vehicle involved. Lower limbs were reported as the most injured body parts in the accidents, corresponding to 24.1%. Among the consequences, 47.7% were counted to be immobilization processes. Orthopedic surgeries responded to 26.1% of procedures. Hospital discharge represented 83.2% in the total number of people leaving the hospital. From all researched accidents, 92.5% did not present casualties, and 56.2% of recorded deaths occurred to people between 60 and 69 years of age. From these, 59.7% were pedestrians, and 47.3% took place in the emergency room, being 28.3% caused by traumatic brain injury. Spatial analysis showed that the deaths were mostly recorded in urban areas, at high density neighborhoods displaying high occurrence of traffic accidents, thus showing a positive correlation. The assessment also pointed out the existence of regions with higher occurrence of traffic accidents. The results of this study also showed a strong correlation between the male sex and the accident occurrence, trauma and injury followed by death in practically all analyzed conditions and age groups, especially among more senior citizens. Traffic accidents presented specific characteristics at elderly groups, thus generating a need for broader studies that could come up with the real figure of the problem and the adoption of adequate and applicable protection measures. The spatial analysis of the accidents per site of occurrence showed to be quite a relevant procedure, as it enabled the identification of priority regions for the implementation of preventive and corrective measures toward preventing and monitoring these occurrences
 
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Publishing Date
2014-06-10
 
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