Bakhos Charles, O'Connor Judy, Kyriakides Tassos, Abou-Nukta Fadi, Bonadies John
Department of Surgery, Hospital of Saint Raphael, New Haven, Connecticut 06511, USA.
J Trauma. 2006 Jul;61(1):131-4. doi: 10.1097/01.ta.0000223463.88422.6a.
This study tests the relationships between early bedside vital capacity (VC) measurement and morbidity, mortality, and resource consumption in geriatric blunt chest trauma patients with rib fractures.
This was a retrospective study examining all patients > or = 65 years old with rib fractures who had a VC measured within 48 hours of their emergency department evaluation. Outcome variables included pulmonary complications, death from pulmonary complications, hospital length of stay (LOS), intensive care unit length of stay (ICU LOS), and discharge disposition.
Thirty-eight patients met the study criteria. The mean age was 80.2 (+/-7.4) years, the mean number of rib fractures was 3.6 (+/-1.6), and the mean ISS was 6.9 (+/-4.7). VC and the percentage of the predicted vital capacity (pVC) were both inversely correlated with LOS (p = 0.0076 and p = 0.0172, respectively). Linear regression analysis suggested that patients with a VC < 1.4 L or < 55% of their pVC had a LOS > 3 days. Mean VC was 36% higher in patients who were discharged home versus those discharged to an extended care facility (ECF; p = 0.025). There was a trend toward significance when comparing VC to ICU LOS (p = 0.079), but none in predicting pulmonary complications (p = 0.3299). No correlations between VC and mortality can be drawn given the single death in the cohort.
Bedside VC is a simple measurement which could predict LOS in elderly patients with rib fractures and may identify those patients requiring ECF upon discharge. Further prospective study may highlight the utility of emergency room VC in determining the disposition of these patients.
本研究旨在测试老年钝性胸部创伤肋骨骨折患者早期床边肺活量（VC）测量值与发病率、死亡率及资源消耗之间的关系。
这是一项回顾性研究，纳入所有年龄≥65岁的肋骨骨折患者，这些患者在急诊科评估后48小时内进行了VC测量。结局变量包括肺部并发症、肺部并发症导致的死亡、住院时间（LOS）、重症监护病房住院时间（ICU LOS）及出院处置情况。
38例患者符合研究标准。平均年龄为80.2（±7.4）岁，平均肋骨骨折数为3.6（±1.6）根，平均损伤严重度评分（ISS）为6.9（±4.7）。VC及预测肺活量百分比（pVC）均与LOS呈负相关（分别为p = 0.0076和p = 0.0172）。线性回归分析表明，VC<1.4 L或<其pVC的55%的患者LOS>3天。出院回家的患者平均VC比出院至长期护理机构（ECF）的患者高36%（p = 0.025）。比较VC与ICU LOS时存在显著趋势（p = 0.079），但在预测肺部并发症方面无显著差异（p = 0.3299）。鉴于队列中仅有1例死亡，无法得出VC与死亡率之间的相关性。
床边VC是一项简单的测量指标，可预测老年肋骨骨折患者的LOS，并可能识别出出院时需要入住ECF的患者。进一步的前瞻性研究可能会突出急诊室VC在确定这些患者处置方式方面的作用。
