{"title":"老年人虚弱程度与地面跌倒后头部撞击位置之间的关系","authors":"Xavier Dubucs MD, MSC , Éric Mercier MD, MSC , Valérie Boucher MSC , Samuel Lauzon , Frederic Balen MD , Sandrine Charpentier MD, PHD , Marcel Emond MD, MSC","doi":"10.1016/j.jemermed.2024.01.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Mild traumatic brain injuries (TBIs) are highly prevalent in older adults, and ground-level falls are the most frequent mechanism of injury.</p></div><div><h3>Objective</h3><p>This study aimed to assess whether frailty was associated with head impact location among older patients who sustained a ground-level fall–related, mild TBI. The secondary objective was to measure the association between frailty and intracranial hemorrhages.</p></div><div><h3>Methods</h3><p>We conducted a planned sub-analysis of a prospective observational study in two urban university-affiliated emergency departments (EDs). Patients 65 years and older who sustained a ground-level fall–related, mild TBI were included if they consulted in the ED between January 2019 and June 2019. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were stratified into the following three groups: robust (CFS score 1–3), vulnerable-frail (CFS score 4–6), and severely frail (CFS score 7–9).</p></div><div><h3>Results</h3><p>A total of 335 patients were included; mean ± SD age was 86.9 ± 8.1 years. In multivariable analysis, frontal impact was significantly increased in severely frail patients compared with robust patients (odds ratio [OR] 4.8 [95% CI 1.4–16.8]; <em>p</em> = 0.01). Intracranial hemorrhages were found in 6.2%, 7.5%, and 13.3% of robust, vulnerable-frail, and severely frail patients, respectively. The OR of intracranial hemorrhages was 1.24 (95% CI 0.44–3.45; <em>p</em> = 0.68) in vulnerable-frail patients and 2.34 (95% CI 0.41–13.6; <em>p</em> = 0.34) in those considered severely frail.</p></div><div><h3>Conclusions</h3><p>This study found an association between the level of frailty and the head impact location in older patients who sustained a ground-level fall. Our results suggest that head impact location after a fall can help physicians identify frail patients. Although not statistically significant, the prevalence of intracranial hemorrhage seems to increase with the level of frailty.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0736467924000076/pdfft?md5=5537b8c00800181d98729b35d0f0d7d4&pid=1-s2.0-S0736467924000076-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Association Between Frailty and Head Impact Location After Ground-Level Fall in Older Adults\",\"authors\":\"Xavier Dubucs MD, MSC , Éric Mercier MD, MSC , Valérie Boucher MSC , Samuel Lauzon , Frederic Balen MD , Sandrine Charpentier MD, PHD , Marcel Emond MD, MSC\",\"doi\":\"10.1016/j.jemermed.2024.01.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Mild traumatic brain injuries (TBIs) are highly prevalent in older adults, and ground-level falls are the most frequent mechanism of injury.</p></div><div><h3>Objective</h3><p>This study aimed to assess whether frailty was associated with head impact location among older patients who sustained a ground-level fall–related, mild TBI. The secondary objective was to measure the association between frailty and intracranial hemorrhages.</p></div><div><h3>Methods</h3><p>We conducted a planned sub-analysis of a prospective observational study in two urban university-affiliated emergency departments (EDs). Patients 65 years and older who sustained a ground-level fall–related, mild TBI were included if they consulted in the ED between January 2019 and June 2019. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were stratified into the following three groups: robust (CFS score 1–3), vulnerable-frail (CFS score 4–6), and severely frail (CFS score 7–9).</p></div><div><h3>Results</h3><p>A total of 335 patients were included; mean ± SD age was 86.9 ± 8.1 years. In multivariable analysis, frontal impact was significantly increased in severely frail patients compared with robust patients (odds ratio [OR] 4.8 [95% CI 1.4–16.8]; <em>p</em> = 0.01). Intracranial hemorrhages were found in 6.2%, 7.5%, and 13.3% of robust, vulnerable-frail, and severely frail patients, respectively. The OR of intracranial hemorrhages was 1.24 (95% CI 0.44–3.45; <em>p</em> = 0.68) in vulnerable-frail patients and 2.34 (95% CI 0.41–13.6; <em>p</em> = 0.34) in those considered severely frail.</p></div><div><h3>Conclusions</h3><p>This study found an association between the level of frailty and the head impact location in older patients who sustained a ground-level fall. Our results suggest that head impact location after a fall can help physicians identify frail patients. 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引用次数: 0
摘要
背景轻度创伤性脑损伤(TBI)在老年人中发病率很高,而地面跌落是最常见的致伤机制。目的本研究旨在评估在遭受地面跌落相关轻度创伤性脑损伤的老年患者中,虚弱程度是否与头部撞击位置有关。方法我们在两所城市大学附属急诊科(ED)进行了一项前瞻性观察研究的计划子分析。2019年1月至2019年6月期间在急诊科就诊的年龄≥65岁、与地面坠落相关的轻度创伤性脑损伤患者均被纳入研究范围。体弱程度采用临床体弱量表进行评估。患者被分为三组:1-3组(强壮)、4-6组(脆弱-虚弱)和7-9组(严重虚弱)。结果共纳入335名患者,平均年龄为(86.9±8.1)岁。在多变量分析中,与体格健壮的患者相比,严重虚弱患者的额部冲击力明显增加(OR:4.8 [95%CI:1.4-16.8],P=0.01)。在体格健壮、脆弱虚弱和严重虚弱的患者中,分别有 6.2%、7.5% 和 13.3% 出现颅内出血。易受影响的虚弱患者颅内出血的 OR 值为 1.24(95IC%:0.44-3.45,P=0.68),被视为严重虚弱的患者颅内出血的 OR 值为 2.34(95IC%:0.41-13.6,P=0.34)。我们的研究结果表明,跌倒后头部撞击位置可帮助医生识别体弱患者。尽管没有统计学意义,但颅内出血的发生率似乎随着虚弱程度的增加而增加。
Association Between Frailty and Head Impact Location After Ground-Level Fall in Older Adults
Background
Mild traumatic brain injuries (TBIs) are highly prevalent in older adults, and ground-level falls are the most frequent mechanism of injury.
Objective
This study aimed to assess whether frailty was associated with head impact location among older patients who sustained a ground-level fall–related, mild TBI. The secondary objective was to measure the association between frailty and intracranial hemorrhages.
Methods
We conducted a planned sub-analysis of a prospective observational study in two urban university-affiliated emergency departments (EDs). Patients 65 years and older who sustained a ground-level fall–related, mild TBI were included if they consulted in the ED between January 2019 and June 2019. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were stratified into the following three groups: robust (CFS score 1–3), vulnerable-frail (CFS score 4–6), and severely frail (CFS score 7–9).
Results
A total of 335 patients were included; mean ± SD age was 86.9 ± 8.1 years. In multivariable analysis, frontal impact was significantly increased in severely frail patients compared with robust patients (odds ratio [OR] 4.8 [95% CI 1.4–16.8]; p = 0.01). Intracranial hemorrhages were found in 6.2%, 7.5%, and 13.3% of robust, vulnerable-frail, and severely frail patients, respectively. The OR of intracranial hemorrhages was 1.24 (95% CI 0.44–3.45; p = 0.68) in vulnerable-frail patients and 2.34 (95% CI 0.41–13.6; p = 0.34) in those considered severely frail.
Conclusions
This study found an association between the level of frailty and the head impact location in older patients who sustained a ground-level fall. Our results suggest that head impact location after a fall can help physicians identify frail patients. Although not statistically significant, the prevalence of intracranial hemorrhage seems to increase with the level of frailty.
期刊介绍:
The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections:
• Original Contributions
• Clinical Communications: Pediatric, Adult, OB/GYN
• Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care
• Techniques and Procedures
• Technical Tips
• Clinical Laboratory in Emergency Medicine
• Pharmacology in Emergency Medicine
• Case Presentations of the Harvard Emergency Medicine Residency
• Visual Diagnosis in Emergency Medicine
• Medical Classics
• Emergency Forum
• Editorial(s)
• Letters to the Editor
• Education
• Administration of Emergency Medicine
• International Emergency Medicine
• Computers in Emergency Medicine
• Violence: Recognition, Management, and Prevention
• Ethics
• Humanities and Medicine
• American Academy of Emergency Medicine
• AAEM Medical Student Forum
• Book and Other Media Reviews
• Calendar of Events
• Abstracts
• Trauma Reports
• Ultrasound in Emergency Medicine