老年创伤患者重大创伤后的长期生存：杯子是半满的。
Long-term survival after major trauma in geriatric trauma patients: the glass is half full.
机构信息
Trauma Division, St. Luke's Hospital and Health Network, Bethlehem, Pennsylvania 18015, USA.
出版信息
J Trauma Acute Care Surg. 2012 May;72(5):1181-5. doi: 10.1097/TA.0b013e31824d0e6d.
BACKGROUND
The objective is to examine the long-term survival status of geriatric trauma patients (GTPs) after major trauma.
METHODS
A 10-year retrospective review at a Level I trauma center was performed. GTP were defined as age ≥ 65 years, with Injury Severity Score ≥ 30. Primary endpoints: survival at hospital discharge and long-term survival and discharge status. Two groups were defined: Abbreviated Injury Score (AIS) head >3 (G1, n = 116) and AIS head ≤ 3 (G2, n = 29). For GTP surviving hospitalization, two subgroups were defined: AIS head >3 (SG1, n = 77) and AIS head ≤ 3 (SG2, n = 20). Comparisons were analyzed for exploratory purposes only by independent t-tests or Mann-Whitney rank sums tests as appropriate. Long-term survival was plotted by a Kaplan-Meier curve.
RESULTS
A total of 145 GTP met inclusion criteria. In-hospital mortality was 33%. Nonsurvivors had lower Glasgow Coma Scale score (6 vs. 14, p < 0.001), higher Injury Severity Score (38 vs. 34, p < 0.003), and lower Revised Trauma Score (5.97 vs. 7.84, p < 0.002). Hospital mortality for G1 was 34% (39 of 116) and for G2 was 31% (9 of 29). In group 1 (n = 116), 39 patients (34%) died while 77 (66%) survived a median of 29 months (interquartile range [IQR] = 6-62). In group 2 (n = 29), 9 patients (31%) died while 20 (69%) survived a median of 46.50 months (IQR = 26.75-79). For the 77 patients who were alive at discharge (subgroup 1, AIS >3), 25 (32%) died while 52 (68%) survived a median of 33 months (IQR = 10.50-72.75). For the 20 patients with AIS ≤ 3 (subgroup 2), 7 of 20 (35%) died while 13 (65%) survived a median of 49 months (IQR = 30.50-93.50). A total of 28 patients (19%) survived more than 5 years from the time of discharge. For these 65 GTPs who are currently alive at the time of follow-up, living status could be determined for 49 (75%) and 33 of 49 (67%) were living at home.
CONCLUSIONS
This study documents appreciable long-term survival for GTP with major injury including severe head injury. A substantial proportion of these patients was able to return home.
LEVEL OF EVIDENCE
III, prognostic/epidemiological study.
背景
本研究旨在探讨老年创伤患者（GTP）在遭受重大创伤后的长期生存状况。
方法
对一家一级创伤中心进行了为期 10 年的回顾性研究。GTP 的定义为年龄≥65 岁，损伤严重程度评分（ISS）≥30。主要终点：出院时的生存率和长期生存率以及出院状态。将患者分为两组：简明损伤评分（AIS）头部>3（G1，n=116）和 AIS 头部≤3（G2，n=29）。对于住院后存活的 GTP，又分为两组：AIS 头部>3（SG1，n=77）和 AIS 头部≤3（SG2，n=20）。仅为探索目的进行了比较，采用独立 t 检验或 Mann-Whitney 秩和检验。采用 Kaplan-Meier 曲线绘制长期生存曲线。
结果
共纳入 145 例 GTP。院内死亡率为 33%。未存活者的格拉斯哥昏迷量表评分较低（6 分 vs. 14 分，p<0.001），ISS 评分较高（38 分 vs. 34 分，p<0.003），修订后的创伤评分较低（5.97 分 vs. 7.84 分，p<0.002）。G1 组（n=116）39 例（34%）死亡，G2 组（n=29）9 例（31%）死亡。在 G1 组（n=116）中，39 例（34%）患者死亡，77 例（66%）存活患者的中位生存时间为 29 个月（四分位间距 [IQR]=6-62）。在 G2 组（n=29）中，9 例（31%）患者死亡，20 例（69%）存活患者的中位生存时间为 46.50 个月（IQR=26.75-79）。出院时存活的 77 例（AIS>3）患者中，25 例（32%）死亡，52 例（68%）存活患者的中位生存时间为 33 个月（IQR=10.50-72.75）。AIS 为≤3 的 20 例患者（SG2）中，7 例（35%）死亡，13 例（65%）存活患者的中位生存时间为 49 个月（IQR=30.50-93.50）。出院后超过 5 年的患者有 28 例（19%）。在这些目前随访时存活的 65 例 GTP 中，49 例（75%）的生存状况可以确定，其中 33 例（67%）在家中生存。
结论
本研究记录了严重创伤老年患者（包括严重头部损伤）可观的长期生存率。这些患者中有相当一部分能够返回家中。
证据水平
III，预后/流行病学研究。
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