调查虚弱对英国主要创伤中心收治的老年创伤患者 6 个月疗效的影响:一项多中心随访研究

Elaine Cole, Robert Crouch, Mark Baxter, Chao Wang, Dhanupriya Sivapathasuntharam, George Peck, Cara Jennings, Heather Jarman
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引用次数: 0

摘要

受伤前的虚弱与老年创伤患者住院后的不良后果有关,但与长期生存和康复的关系尚不清楚。我们的目的是调查老年体弱患者在入住重创中心(MTC)六个月后的出院生存率和与健康相关的生活质量(HRQoL)。这是一项多中心研究,研究对象是在五家重创中心住院的年龄≥ 65 岁的患者。在出院时和六个月后通过问卷收集数据。主要结果是随访时患者使用 Euroqol EQ5D-5 L 视觉模拟量表(VAS)报告的 HRQoL。次要结果包括根据 EQ5D 维度得出的健康状况和随访时的护理要求。研究人员进行了多变量线性回归分析,以评估预测变量与随访时EQ-5D-5 L视觉模拟量表之间的关联。54名患者在随访期间死亡,其中三分之二(64%)在受伤前被归类为体弱者,而在133名幸存者中有21人(16%)被归类为体弱者。在出院时,体弱和非体弱患者的自我报告 HRQoL 没有差异(平均 EQ-VAS: 体弱 55.8 vs. 非体弱 64.1,p = 0.137),但在随访时,非体弱组的 HRQoL 有所改善,而体弱患者的 HRQoL 则有所恶化(平均 EQ-VAS: 体弱 50.0 vs. 非体弱 65.8,p = 0.009)。体弱患者在 6 个月时生活质量差(VAS ≤ 50)的比例增加了两倍(体弱:65% 对非体弱:30%,P < 0.009)。虚弱(β-13.741 [95% CI -25.377, 2.105],p = 0.02)、年龄增加(β-1.064 [95% CI [-1.705, -0.423] p = 0.00)和非居家出院(β-12.017 [95% CI [118.403, 207.203],p = 0.04)与随访时的 HRQoL 较差有关。随访时,体弱患者对专业护理人员的需求增加了五倍(体弱:25% vs. 非体弱:4%,p = 0.01)。体弱与创伤出院后死亡率的增加有关,体弱的老年创伤幸存者在出院后六个月的 HRQoL 较差,护理需求增加。受伤前的虚弱是创伤后较长期的 HRQoL 较差的预测因素,认识到这一点后,应及早制定专科路径和出院计划。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Investigating the effects of frailty on six-month outcomes in older trauma patients admitted to UK major trauma centres: a multi-centre follow up study
Pre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission. This was a multi-centre study of patients aged ≥ 65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5 L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5 L VAS at follow up. Fifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p = 0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p = 0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤ 50) for frail patients (Frail: 65% vs. Not-frail: 30% p < 0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p = 0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p = 0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p = 0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p = 0.01). Frailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.
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