Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, University of Arizona Medical Center, Tuscon, AZ.
Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, University of Arizona Medical Center, Tuscon, AZ.
J Am Coll Surg. 2014 Jul;219(1):10-17.e1. doi: 10.1016/j.jamcollsurg.2014.03.020. Epub 2014 Mar 19.
The Frailty Index has been shown to predict discharge disposition in geriatric patients. The aim of this study was to validate the modified 15-variable Trauma-Specific Frailty Index (TSFI) to predict discharge disposition in geriatric trauma patients. We hypothesized that TSFI can predict discharge disposition in geriatric trauma patients.
We performed a 2-year (2011-2013) prospective analysis of all geriatric trauma patients presenting to our Level I trauma center. Patient discharge disposition was dichotomized into unfavorable (discharge to skilled nursing facility or death) and favorable (discharge to home or rehabilitation center) discharge disposition. Patients were evaluated using the developed 15-variable TSFI. Multivariate logistic regression was performed to identify factors that predict unfavorable discharge disposition.
A total of 200 patients were enrolled for validation of TSFI. Mean age was 77 ± 12.1 years, median Injury Severity Score was 15 (interquartile range [IQR] 9 to 20), median Glasgow Coma Scale score was 14 (IQR 13 to 15), and median Frailty Index score was 0.20 (IQR 0.17 to 0.28); 29.5% (n = 59) patients had unfavorable discharge. After adjusting for age, sex, Injury Severity Score, Head Abbreviated Injury Scale, and vitals on admission, Frailty Index (odds ratio = 1.5; 95% CI, 1.1-2.5) was the only significant predictor for unfavorable discharge disposition. Age (odds ratio = 1.2; 95% CI, 0.9-3.1; p = 0.2) was not predictive of unfavorable discharge disposition.
The 15-variable TSFI is an independent predictor of unfavorable discharge disposition in geriatric trauma patients. The Trauma-Specific Frailty Index is an effective tool that can aid clinicians in planning discharge disposition of geriatric trauma patients.
II Prognostic Studies-Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
虚弱指数已被证明可预测老年患者的出院去向。本研究旨在验证改良的 15 变量创伤特异性虚弱指数（TSFI）是否可预测老年创伤患者的出院去向。我们假设 TSFI 可以预测老年创伤患者的出院去向。
我们对 2011 年至 2013 年期间到我们的一级创伤中心就诊的所有老年创伤患者进行了为期 2 年的前瞻性分析。患者的出院去向分为不良（出院至康复护理机构或死亡）和良好（出院至家庭或康复中心）。使用开发的 15 变量 TSFI 评估患者。采用多变量逻辑回归确定预测不良出院去向的因素。
共有 200 例患者纳入 TSFI 验证。平均年龄为 77±12.1 岁，中位数损伤严重程度评分 15（四分位距 9 至 20），中位数格拉斯哥昏迷量表评分为 14（四分位距 13 至 15），中位数虚弱指数评分为 0.20（四分位距 0.17 至 0.28）；29.5%（n=59）患者出院不良。调整年龄、性别、损伤严重程度评分、头部简明损伤量表和入院时生命体征后，虚弱指数（优势比=1.5；95%置信区间，1.1-2.5）是不良出院去向的唯一显著预测因子。年龄（优势比=1.2；95%置信区间，0.9-3.1；p=0.2）不能预测不良出院去向。
15 变量 TSFI 是老年创伤患者不良出院去向的独立预测因子。创伤特异性虚弱指数是一种有效的工具，可以帮助临床医生为老年创伤患者规划出院去向。
II 预后研究-调查患者特征对疾病结局的影响。
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