Lee Jacques, Sirois Marie-Josee, Moore Lynne, Perry Jeffrey, Daoust Raoul, Griffith Lauren, Worster Andrew, Lang Eddy, Emond Marcel
Department of Emergency Services and Scientist, Clinical Epidemiology Unit, Sunnybrook Research Institute, Toronto, Ontario, Canada.
Faculte de Medicine, Universite Laval, Quebec, Canada.
Age Ageing. 2015 Jul;44(4):624-9. doi: 10.1093/ageing/afv054. Epub 2015 May 5.
minor traumatic injuries among independent older people have received little attention to date, but increasingly the impact of such injuries is being recognised.
we assessed the frequency and predictors of acute health care use, defined as return to the emergency department (ED) or hospitalisation.
national multicentre prospective observational study.
eight Canadian teaching EDs between April 2009 and April 2013.
a total of 1,568 patients aged 65-100 years, independent in basic activities of daily living, discharged from ED following a minor traumatic injury.
trained assessors measured baseline data including demographics, functional status, cognition, comorbidities, frailty and injury severity. We then conducted follow-up telephone interviews at 6 months to assess subsequent acute health care use. We used log-binomial regression analyses to identify predictors of acute health care use, and reported relative risks and 95% CIs.
participants' mean age was 77.0, 66.4% female, and their injuries included contusions (43.5%), lacerations (25.1%) and fractures (25.4%). The cumulative rate of acute health care use by 6 months post-injury was 21.5% (95% CI: 19.0-24.3%). The strongest predictors of acute health care use within 6 months were cognitive impairment, RR = 1.6 (95% IC: 1.2-2.1) and the mechanism of injury including pedestrian struck or recreational injuries, RR = 1.6 (95% CI 1.2-2.2).
among independent community living older persons with a minor injury, cognitive impairment and mechanism of injury were independent risk factors for acute healthcare use. Future studies should look at whether tailored discharge planning can reduce the need for acute health care use.
迄今为止，独立生活的老年人遭受的轻度创伤性损伤很少受到关注，但此类损伤的影响正日益得到认可。
我们评估了急性医疗保健使用的频率和预测因素，急性医疗保健使用定义为返回急诊科（ED）或住院治疗。
全国多中心前瞻性观察研究。
2009年4月至2013年4月期间的八家加拿大教学医院急诊科。
共有1568名年龄在65 - 100岁之间、日常生活基本活动独立的患者，在轻度创伤性损伤后从急诊科出院。
经过培训的评估人员测量了基线数据，包括人口统计学、功能状态、认知、合并症、虚弱程度和损伤严重程度。然后，我们在6个月时进行随访电话访谈，以评估随后的急性医疗保健使用情况。我们使用对数二项回归分析来确定急性医疗保健使用的预测因素，并报告相对风险和95%置信区间。
参与者的平均年龄为77.0岁，女性占66.4%，其损伤包括挫伤（43.5%）、撕裂伤（25.1%）和骨折（25.4%）。受伤后6个月内急性医疗保健使用的累积发生率为21.5%（95%置信区间：19.0 - 24.3%）。6个月内急性医疗保健使用的最强预测因素是认知障碍，相对风险（RR）= 1.6（95%置信区间：1.2 - 2.1），以及损伤机制，包括行人被撞或娱乐性损伤，RR = 1.6（95%置信区间1.2 - 2.2）。
在独立生活在社区的轻度受伤老年人中，认知障碍和损伤机制是急性医疗保健使用的独立危险因素。未来的研究应探讨定制的出院计划是否可以减少急性医疗保健使用的需求。
