Nanjayan Shashi Kumar, John Joby, Swamy Girish, Mitsiou Konstantinos, Tambe Amol, Abuzakuk Tarek
Department of Trauma & Orthopaedics, Royal Derby Hospital, Derby DE22 3NE, UK.
Department of Trauma & Orthopaedics, Royal Derby Hospital, Derby DE22 3NE, UK.
Injury. 2014 Jul;45(7):1080-4. doi: 10.1016/j.injury.2014.02.005. Epub 2014 Feb 15.
The purpose of our study was to analyse the incidence and factors predicting the 'change in discharge destination' in patients with fractured neck of femur who were treated surgically.
Fifteen hundred and seventy-three consecutive patients admitted with a fractured neck of femur, residing in their own home prior to admission were studied. Patients who did not have an operation (n=70) for their hip fracture were excluded from the study. Residential location in the UK is broadly categorised as:
A downward drift in "discharge destination" of 20% was noted after analysis. Univariate analysis revealed that age, gender, AMT score, place of fall, type of fracture, walking ability outdoor and indoor, ASA grade, medical co-morbidity requiring physician review and delay beyond 36h to surgery had a significant effect. Multiple logistic regression analysis revealed that increasing age, male gender (OR=1.67), accompaniment for outdoor mobilisation (OR=1.96), increasing ASA grade, AMT score <6 (OR=4.86), pre-operative medical condition requiring physician review (OR=2.27), delay greater than 36h for medical reasons (OR=4.38) were predictors of the change in discharge destination.
The most important predictors of the change in the discharge destination were the medical condition, cognitive and physical function of the patient at admission. Male gender and increasing age were contributory. The only clinician dependent factor that seemed to affect this change of residential status was delay to surgery secondary to medical problems. Awareness of key predictors that affect the "discharge destination" can be useful for the multidisciplinary team and patients' families to evaluate and plan for an early, satisfactory and appropriate referral to either community services or institutional care, which in turn could have a significant socioeconomic impact.
我们研究的目的是分析接受手术治疗的股骨颈骨折患者中“出院目的地改变”的发生率及预测因素。
对1573例连续收治的股骨颈骨折患者进行研究，这些患者入院前居住在自己家中。未接受髋关节骨折手术的患者（n = 70）被排除在研究之外。英国的居住地点大致分为：
分析后发现“出院目的地”下降了20%。单因素分析显示，年龄、性别、AMT评分、跌倒地点、骨折类型、室内外行走能力、ASA分级、需要医生复查的合并症以及手术延迟超过36小时有显著影响。多因素逻辑回归分析显示，年龄增加、男性（OR = 1.67）、有户外活动陪同（OR = 1.96）、ASA分级增加、AMT评分<6（OR = 4.86）、术前需要医生复查的病情（OR = 2.27）、因医疗原因延迟超过36小时（OR = 4.38）是出院目的地改变的预测因素。
出院目的地改变的最重要预测因素是患者入院时的病情、认知和身体功能。男性和年龄增加也有影响。似乎影响这种居住状态改变的唯一依赖临床医生的因素是因医疗问题导致的手术延迟。了解影响“出院目的地”的关键预测因素对多学科团队和患者家属评估并计划早期、满意且合适地转诊至社区服务或机构护理可能有用，这反过来可能会产生重大的社会经济影响。
