使用 CAREFALL 分诊工具评估因跌倒而到急诊科就诊的老年患者中可改变的风险因素的患病率。

Assessing the prevalence of modifiable risk factors in older patients visiting an ED due to a fall using the CAREFALL Triage Instrument.

机构信息

Department of Traumatology, Academic Medical Center, Amsterdam, The Netherlands.

出版信息

Am J Emerg Med. 2010 Nov;28(9):994-1001. doi: 10.1016/j.ajem.2009.06.003. Epub 2010 Feb 25.

DOI:10.1016/j.ajem.2009.06.003

PMID:20825929

Abstract

OBJECTIVE

Falls in older people are a common presenting complaint. Knowledge of modifiable risk factors may lead to a more tailored approach to prevent recurrent falls and/or fractures. We investigated prevalence of 8 modifiable risk factors for recurrent falling and/or a serious consequence of the fall among older patients visiting the emergency department after a fall with the Combined Amsterdam and Rotterdam Evaluation of Falls Triage Instrument (CTI), a self-administrated questionnaire that consists of questions concerning demographics, possible cause(s) of the fall, and questions relating to (modifiable) risk factors for falling.

METHODS

After treatment for their injuries, 1077 consecutive patients 65 years or older visiting the accident and emergency department due to a fall were evaluated by the CTI. The following were assessed: impaired vision, mobility disorder, fear of falling, mood disorder, high risk of osteoporosis, orthostatic hypotension, incontinence, and polypharmacy.

RESULTS

The percentage of respondents who returned the questionnaire was 59.3%. The mean (SD) age was 78.5 (7.5) years, and 57.8% experienced a fall with serious consequences. There were 60.9% of patients with a recurrent fall versus 51% with a first fall who experienced with a serious consequence (P = .025). Age and risk factors mobility disorder (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3), high risk of osteoporosis (OR, 2.0; 95% CI, 1.2-3.2), incontinence (OR, 1.7; 95% CI, 1.0-2.7), fear of falling (OR, 2.2; 95% CI, 1.3-3.7), and orthostatic hypotension (OR, 2.4; 95% CI, 1.4-4.2) were independently associated with a recurrent fall. Age and high risk of osteoporosis were the only risk factors predicting a serious consequence of a fall (OR, 4.6; 95% CI, 2.9-7.2).

CONCLUSIONS

Age and 5 modifiable risk factors assessed with the CTI were independently associated with a recurrent fall. Only high risk of osteoporosis was associated with a serious consequence.

摘要

目的

老年人跌倒较为常见，了解可改变的危险因素可能有助于针对老年人跌倒复发和/或跌倒严重后果制定更具针对性的预防措施。我们使用可自行填写的阿姆斯特丹和鹿特丹跌倒评估分类工具（CTI）调查问卷，对因跌倒就诊于急诊科的老年患者进行调查，以评估 8 种可改变的跌倒复发和/或跌倒严重后果的危险因素的发生率。CTI 调查问卷包含人口统计学信息、可能的跌倒原因以及与跌倒相关的（可改变的）危险因素。

方法

对因跌倒受伤后就诊于急诊科的 1077 例年龄 65 岁及以上的连续患者使用 CTI 进行评估。评估内容包括视力障碍、行动障碍、恐摔、情绪障碍、骨质疏松高风险、体位性低血压、尿失禁和药物滥用。

结果

回收调查问卷的患者比例为 59.3%。患者的平均（标准差）年龄为 78.5（7.5）岁，57.8%的患者跌倒后出现严重后果。与首次跌倒的患者（51%）相比，跌倒复发的患者（60.9%）更易出现严重后果（P =.025）。年龄和行动障碍（比值比 [OR]，1.9；95%置信区间 [CI]，1.1-3.3）、骨质疏松高风险（OR，2.0；95% CI，1.2-3.2）、尿失禁（OR，1.7；95% CI，1.0-2.7）、恐摔（OR，2.2；95% CI，1.3-3.7）和体位性低血压（OR，2.4；95% CI，1.4-4.2）是跌倒复发的独立危险因素。年龄和骨质疏松高风险是预测跌倒严重后果的唯一危险因素（OR，4.6；95% CI，2.9-7.2）。