Bergeron Eric, Lavoie André, Moore Lynne, Clas David, Rossignol Michel
Charles-LeMoyne Hospital, Greenfield Park, QC.
Can J Surg. 2005 Oct;48(5):361-6.
Length of hospitalization is a good indicator of resource utilization. Older patients are increasingly suffering trauma, and comorbid medical conditions are also increasing. Our objective was to determine the separate and combined effect of these 2 factors on length of hospital stay for trauma patients in a tertiary trauma centre.
All 994 consecutive trauma patients surviving to hospital discharge between Apr. 1, 2000, and Mar. 31, 2001, were identified. Patient characteristics, injury severity and length of hospitalization were obtained from the hospital trauma registry. Each medical record was then reviewed for completeness of information and assessment of comorbid conditions. A multivariate linear regression model was developed to predict logarithmic length of stay from age and presence of a cormorbid condition while adjusting for the Injury Severity Score (ISS).
The mean age of the patients was 49.7 (range from 14-100) years and median ISS was 9 (range from 1-50). At least 1 comorbid condition was present in 321 (32%) patients. Mean length of hospital stay was 15.3 days. The proportion of patients with a comorbid condition increased steadily with age, from 8.7% before the age of 55 years to 92% at 85 or more years of age (p < 0.001). According to the multivariate model, the presence of comorbidity, age and ISS were all independent predictors of hospital stay (p < 0.001). When applied to patients with the mean ISS value of 9, the model showed an increase in length of hospitalization for patients with a comorbid condition over those without; (3.6 v. 13.1 d for patients < 55 and > or = 85 yr respectively). Length of hospital stay increased particularly with neurologic and pulmonary problems.
Comorbidity and age were both independently significant predictors of length of hospitalization over and beyond that which is expected based on the severity of the injuries. With an aging population, this phenomenon should severely affect resource utilization in trauma centres in the near future. Researchers should take account of both age and comorbidity in order to compare trauma populations.
住院时间是资源利用的一个良好指标。老年患者遭受创伤的情况日益增多，同时并存的内科疾病也在增加。我们的目的是确定这两个因素对三级创伤中心创伤患者住院时间的单独及综合影响。
确定了2000年4月1日至2001年3月31日期间所有994例存活至出院的连续创伤患者。患者特征、损伤严重程度和住院时间从医院创伤登记处获取。然后对每份病历进行审查，以确保信息完整并评估并存疾病。建立了一个多元线性回归模型，在调整损伤严重程度评分（ISS）的同时，根据年龄和并存疾病的存在情况预测住院时间的对数。
患者的平均年龄为49.7岁（范围为14 - 100岁），ISS中位数为9（范围为1 - 50）。321例（32%）患者至少存在1种并存疾病。平均住院时间为15.3天。并存疾病患者的比例随年龄稳步增加，从55岁之前的8.7%增至85岁及以上的92%（p < 0.001）。根据多元模型，并存疾病的存在、年龄和ISS都是住院时间的独立预测因素（p < 0.001）。当应用于ISS平均值为9的患者时，该模型显示，有并存疾病的患者比无并存疾病的患者住院时间增加；（<55岁和≥85岁患者分别为3.6天对13.1天）。住院时间尤其因神经和肺部问题而增加。
并存疾病和年龄都是住院时间的独立显著预测因素，超出了基于损伤严重程度所预期的范围。随着人口老龄化，这一现象在不久的将来应会严重影响创伤中心的资源利用。研究人员在比较创伤人群时应同时考虑年龄和并存疾病。
