衰弱评分是否有助于预测老年创伤患者的预后?一项大型创伤中心的回顾性研究

IF 1.7 4区 医学 Q2 EMERGENCY MEDICINE
Charlotte G Underwood MBChB, Andrew McCombie BSc BA(Hons)(Cant), PhD(Otago), Maria Nonis MBChB, Laura R Joyce FACEM, AFRACMA, MBChB, BMedSc(Hons), MMedEd
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引用次数: 0

摘要

本研究的目的是评估在新西兰奥特罗阿(Aotearoa)接受高等急诊科(tertiary ED)治疗时出现严重创伤的老年患者虚弱对预后的影响。方法对2022年1月1日至12月31日期间在新西兰基督城急诊科就诊的65岁及以上严重创伤患者进行回顾性观察研究。主要结局是住院死亡率或出院时护理需求增加的综合结果。检索了人口统计细节、院内管理和结果。在入院时前瞻性地记录临床虚弱量表评分。对离散因变量进行了单变量分析。进行了中介分析,其中虚弱是年龄和主要结局变量之间的中介。结果采用排除标准后,纳入134例患者进行分析。即使在控制了年龄之后,临床虚弱量表上每增加一分,住院死亡率或出院时护理需求增加的几率也增加36.4%(95%置信区间:9.4-85)。这些主要创伤患者中只有33%在就诊时得到了适当的识别,因此接受了创伤小组的激活,随着虚弱程度的增加,激活率也随之恶化。结论老年创伤患者存在严重损伤未得到充分认识。虚弱评分可以在急诊科中用于早期识别那些预后不良的高风险患者,以便采取积极的管理策略来优化他们的护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Does frailty scoring help to predict outcomes in older patients with major trauma? A retrospective study at a major trauma centre

Does frailty scoring help to predict outcomes in older patients with major trauma? A retrospective study at a major trauma centre

Objective

The objective of the present study was to evaluate the impact of frailty on outcomes for older patients presenting with major trauma to a tertiary ED in Aotearoa New Zealand.

Methods

A retrospective observational study of patients 65 years and older who presented to Christchurch ED, New Zealand, with major trauma between 1 January and 31 December 2022. The primary outcome was a composite of in-hospital mortality or increased care requirements on discharge from hospital. Demographic details, in-hospital management, and outcomes were retrieved. Clinical Frailty Scale scoring had prospectively been recorded at the time of admission. Univariable analysis of discrete dependent variables was carried out. Mediation analysis was undertaken, wherein frailty was the mediator between age and the primary outcome variable.

Results

After exclusion criteria were applied, 134 patients were included for analysis. Even after controlling for age, for every additional point on the Clinical Frailty Scale, the odds of in-hospital mortality or increased care requirements on discharge increased by 36.4% (95% confidence interval: 9.4–85). Only 33% of these major trauma patients were appropriately identified at presentation and so received a trauma team activation, with worsened activation rates with increasing frailty.

Conclusions

The presence of significant injuries in older trauma patients is under-recognised. Frailty scoring could be used in the ED for early identification of those patients at high risk of poor outcomes, so that active management strategies can be put in place to optimise their care.

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来源期刊
Emergency Medicine Australasia
Emergency Medicine Australasia 医学-急救医学
CiteScore
3.70
自引率
13.00%
发文量
217
审稿时长
6-12 weeks
期刊介绍: Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.
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