老年人平地跌倒的长期后果。
Long-term outcomes of ground-level falls in the elderly.
机构信息
From the Department of Surgery (P.A.-C.), New York University School of Medicine, New York, New York; Departments of Surgery (L.M., R.V.M.), Pediatrics (B.E.E.), and Epidemiology (B.E.E.), Division of Gerontology and Geriatric Medicine (W.M.), Department of Medicine, and Harborview Injury Prevention and Research Center (B.E.E.), University of Washington; and Group Health Research Institute (C.D.M.), Seattle, Washington.
出版信息
J Trauma Acute Care Surg. 2014 Feb;76(2):498-503; discussion 503. doi: 10.1097/TA.0000000000000102.
BACKGROUND
For older adults, even ground-level falls (GLFs) can result in multiple injuries and are associated with significant morbidity and mortality. Previous studies have focused on in-hospital outcomes and patients with isolated injuries. Our study examined outcomes following discharge for older adults who were hospitalized following a GLF.
METHODS
A retrospective cohort study of patients older than 65 years admitted to a regional Level I trauma center, from 2005 to 2008, after a GLF was conducted. Hospital trauma registry data were linked to state hospital discharge data and the death certificate registry. Skilled nursing facilities (SNFs) were contacted to verify ultimate patient placement, with follow-up through December 2010. Kaplan-Meier and Cox proportional hazards models were used to analyze postdischarge mortality.
RESULTS
There were 1,352 consecutive admissions; 48% had an Injury Severity Score (ISS) greater than 15, and 12% died during admission. Of the patients who survived hospitalization, 51% were discharged to an SNF, 33% to home without assistance, 6% to home with assistance, and 5% to inpatient rehabilitation facilities. Within 1 year of injury, 44.6% of the patients were readmitted. The 1-year mortality for the overall cohort was 33%; for patients who were discharged alive, the 1-year mortality was 24%. After adjusting for confounders, patients discharged to an SNF had a threefold greater risk of 1-year mortality (hazard ratio, 2.82; 95% confidence interval, 1.86-4.28), compared with patients discharged home with no assistance. Of the patients discharged to an SNF, 48% died by the end of the follow-up period (mean, 28.2 months), and 61% of these patients died while residing at an SNF.
CONCLUSION
GLFs in the elderly result in severe injury, high rate of readmissions, and increased mortality, both in-hospital and after discharge. Overall, only one third of the patients were discharged home to independent living. Future efforts should examine whether improvements in the quality of posthospital care affect both mortality and functional outcomes.
LEVEL OF EVIDENCE
Prognostic and epidemiologic study, level III.
背景
对于老年人来说，即使是平地跌倒（GLFs）也可能导致多处受伤，并伴有显著的发病率和死亡率。以前的研究集中在住院期间的结果和单一损伤的患者身上。我们的研究调查了在 GLF 后住院的老年人出院后的结果。
方法
对 2005 年至 2008 年期间在一个地区一级创伤中心因 GLF 住院的年龄大于 65 岁的患者进行了回顾性队列研究。将医院创伤登记数据与州医院出院数据和死亡证明登记处联系起来。联系了熟练护理设施（SNFs）以确认最终患者的安置情况，并在 2010 年 12 月之前进行了随访。使用 Kaplan-Meier 和 Cox 比例风险模型分析出院后的死亡率。
结果
共连续收治 1352 例患者；48%的患者损伤严重程度评分（ISS）大于 15，12%的患者在住院期间死亡。在存活住院的患者中，51%出院到 SNF，33%出院到无人协助的家中，6%出院到有人协助的家中，5%出院到住院康复设施。在受伤后 1 年内，44.6%的患者再次入院。整个队列的 1 年死亡率为 33%；对于出院存活的患者，1 年死亡率为 24%。在调整混杂因素后，出院到 SNF 的患者 1 年死亡率增加了三倍（风险比，2.82；95%置信区间，1.86-4.28），与出院到无人协助的家中的患者相比。出院到 SNF 的患者中，48%在随访结束时死亡（平均 28.2 个月），其中 61%的患者在 SNF 居住时死亡。
结论
老年人平地跌倒导致严重损伤、高再入院率和住院期间和出院后死亡率增加。总体而言，只有三分之一的患者出院回家独立生活。未来的研究应探讨改善住院后护理质量是否会影响死亡率和功能结果。
证据水平
预后和流行病学研究，III 级。
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