Shapiro M J, Partridge R A, Jenouri I, Micalone M, Gifford D
Rhode Island Hospital, Division of Emergency Medicine and Injury Prevention Center, Providence, RI 02903, USA.
Acad Emerg Med. 2001 Jan;8(1):78-81. doi: 10.1111/j.1553-2712.2001.tb00560.x.
To describe injury types, patterns, and health status in independently functioning elder patients presenting to the emergency department (ED) after a minor traumatic injury; and 2) to assess short-term functional decline in this population at three-month follow-up.
This was a prospective observational study of elder patients (age > 65 years) discharged home from the ED after evaluation and treatment for an acute traumatic injury. Patients were excluded if they were not independently functioning or had an acute delirium. Type and mechanism of injury sustained during the ED visit were recorded. Functional status was assessed during the visit and three months later using activities of daily living (ADL) and instrumental activities of daily living (IADL) scores.
One hundred six subjects were enrolled in the study. Mean age was 74.8 years. The most common injuries observed were contusion (n = 35, 33%, 95% CI = 24% to 42%), fractures (n = 28, 26%, 95% CI = 18% to 36%), lacerations (n = 20, 19%, 95% CI = 12% to 28%), and sprains (n = 12, 11%, 95% CI = 6% to 19%), which represented more than 90% of the injuries. Eighty-eight (83%) patients completed three-month follow up. Of these, 6 of 88 (6.82%, 95% CI = 3% to 14%) declined in their ADL scores and 20 of 88 (22.73%, 95% CI = 14% to 33%) declined in their IADL scores at three months. Primary injury type, specifically contusion, was more prevalent in patients who had a decline in ADL score, as compared with those who did not have a decline in ADL score (chi-square p<0.001). In addition, anatomic locations of injury were different between those patients with and without a decline in IADL scores (chi-square p = 0.008). Gender differences were also found; females were more likely to be injured by a slip, trip, or fall indoors (36 of 58, 62%) than outdoors (22 of 58, 38%); males injured by this mechanism were more likely to be injured outdoors (14 of 20, 70%) as opposed to indoors (6 of 20, 30%), chi-square p = 0.013.
A significant proportion of functional elder patients with minor traumatic injury are at risk for short-term functional decline. Decline in ADL is related to injury type, while IADL decline is related to anatomic location of injury. Emergency physicians should consider initiating follow-up evaluation and possible intervention in highly functioning elders after minor traumatic injury.
描述在轻微创伤性损伤后到急诊科（ED）就诊的独立生活的老年患者的损伤类型、模式和健康状况；2）评估该人群在三个月随访时的短期功能衰退情况。
这是一项对因急性创伤性损伤在急诊科接受评估和治疗后出院回家的老年患者（年龄>65岁）进行的前瞻性观察研究。如果患者不能独立生活或患有急性谵妄，则将其排除。记录在急诊科就诊期间遭受的损伤类型和机制。在就诊时和三个月后使用日常生活活动（ADL）和工具性日常生活活动（IADL）评分评估功能状态。
106名受试者纳入研究。平均年龄为74.8岁。观察到的最常见损伤为挫伤（n = 35，33%，95%CI = 24%至42%）、骨折（n = 28，26%，95%CI = 18%至36%）、撕裂伤（n = 20，19%，95%CI = 12%至28%）和扭伤（n = 12，11%，95%CI = 6%至19%），这些损伤占损伤总数的90%以上。88名（83%）患者完成了三个月的随访。其中，88名中有6名（6.82%，95%CI = 3%至14%）在三个月时ADL评分下降，88名中有20名（22.73%，95%CI = 14%至33%）在三个月时IADL评分下降。与ADL评分未下降的患者相比，ADL评分下降的患者中主要损伤类型（特别是挫伤）更为普遍（卡方检验p<0.001）。此外，IADL评分下降和未下降的患者之间损伤的解剖部位不同（卡方检验p = 0.008）。还发现了性别差异；女性在室内滑倒、绊倒或摔倒受伤的可能性更大（58名中的36名，62%），而在室外受伤的可能性较小（58名中的22名，38%）；男性因这种机制受伤在室外的可能性更大（20名中的14名，70%），而在室内的可能性较小（20名中的6名，30%），卡方检验p = 0.013。
相当一部分功能正常的轻微创伤性损伤老年患者存在短期功能衰退的风险。ADL下降与损伤类型有关，而IADL下降与损伤的解剖部位有关。急诊医生应考虑在轻微创伤性损伤后对功能良好的老年人启动随访评估和可能的干预措施。
