Department of Trauma, Critical Care and Acute Care Surgery, Lancaster General Hospital, Lancaster, Pennsylvania 17602, USA.
J Trauma Acute Care Surg. 2012 Aug;73(2):435-40. doi: 10.1097/TA.0b013e31825c7cf4.
Injured geriatric patients pose unique challenges to the trauma team because of their abnormal responses to shock and injury. We have developed the high-risk geriatric protocol (GP) that seeks to identify high-risk geriatric patients. We hypothesized that a high-risk GP would improve outcome in this select group of patients.
Patients from 2000 to 2010 were included. Patients 65 years or older who met high-risk GP based on comorbidities and/or physiologic parameters were compared with those patients who had not received GP before its implementation as well as other non-GP patients. This protocol includes a geriatric consultation, as well as a lactate levels, arterial blood gas levels, and echo test to assess for occult shock. Age, trauma activation, preexisting conditions, Injury Severity Score, Revised Trauma Score, and mortality were reviewed. Univariate and multivariate analyses were conducted to identify factors predictive of mortality.
A total of 3,902 patients were evaluated. Patients receiving GP were less likely to die (odds ratio, 0.63 [0.39-0.99], p = 0.046). For all patients, there was a dramatic increase in mortality for those patients older than 75 years.
The GP, adjusted for other covariates, significantly reduced mortality in our patient population. Thus, this study confirms the overall effectiveness of our GP, which is hallmarked by prompt identification of those patients with occult shock and a multidisciplinary care of the aged population.
由于老年患者对休克和损伤的异常反应，受伤的老年患者给创伤团队带来了独特的挑战。我们已经制定了高危老年患者方案（GP），旨在识别高危老年患者。我们假设高危 GP 会改善这组特定患者的预后。
纳入了 2000 年至 2010 年的患者。根据合并症和/或生理参数符合高危 GP 的 65 岁及以上患者与在实施该方案之前未接受 GP 的患者以及其他非 GP 患者进行了比较。该方案包括老年咨询，以及乳酸水平、动脉血气水平和超声心动图检查，以评估隐匿性休克。回顾了年龄、创伤激活、既往疾病、损伤严重程度评分、修订创伤评分和死亡率。进行了单变量和多变量分析，以确定预测死亡率的因素。
共评估了 3902 名患者。接受 GP 的患者死亡的可能性较小（比值比，0.63 [0.39-0.99]，p=0.046）。对于所有患者，年龄大于 75 岁的患者死亡率显著增加。
调整其他协变量后，GP 显著降低了我们患者人群的死亡率。因此，这项研究证实了我们的 GP 的总体有效性，其特点是迅速识别出隐匿性休克的患者，并对老年人群进行多学科护理。
