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老年人跌倒后急诊复诊频率及死亡率

Frequency of ED revisits and death among older adults after a fall.

作者信息

Liu Shan W, Obermeyer Ziad, Chang Yuchiao, Shankar Kalpana N

机构信息

Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.

Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.

出版信息

Am J Emerg Med. 2015 Aug;33(8):1012-8. doi: 10.1016/j.ajem.2015.04.023. Epub 2015 Apr 20.

Abstract

INTRODUCTION

Falls among older adults (aged ≥65 years) are the leading cause of both injury deaths and emergency department (ED) visits for trauma. We examine the characteristics and prevalence of older adult ED fallers as well as the recurrent ED visit and mortality rate.

METHODS

This was a retrospective analysis of a cohort of elderly fall patients who presented to the ED between 2005 and 2011 of 2 urban, level 1 trauma, teaching hospitals with approximately 80000 to 95000 annual visits. We examined the frequency of ED revisits and death at 3 days, 7 days, 30 days, and 1 year controlling for certain covariates.

RESULTS

Our cohort included 21340 patients. The average age was 78.6 years. An increasing proportion of patients revisited the ED over the course of 1 year, ranging from 2% of patients at 3 days to 25% at 1 year. Death rates increased from 1.2% at 3 days to 15% at 1 year. A total of 10728 patients (50.2%) returned to the ED at some point during our 7-year study period, and 36% of patients had an ED revisit or death within 1 year. In multivariate logistic regression, male sex and comorbidities were associated with ED revisits and death.

CONCLUSION

More than one-third of older adult ED fall patients had an ED revisit or died within 1 year. Falls are one of the geriatric syndromes that contribute to frequent ED revisits and death rates. Future research should determine whether falls increase the risk of such outcomes and how to prevent future fall and death.

摘要

引言

老年人(年龄≥65岁)跌倒既是创伤导致伤害死亡的主要原因,也是急诊就诊的主要原因。我们研究了老年急诊跌倒患者的特征和患病率,以及再次急诊就诊率和死亡率。

方法

这是一项对2005年至2011年间到两家城市一级创伤教学医院急诊科就诊的老年跌倒患者队列的回顾性分析,这两家医院每年就诊人数约为8万至9.5万。我们在控制某些协变量的情况下,研究了3天、7天、30天和1年时急诊再次就诊和死亡的频率。

结果

我们的队列包括21340名患者。平均年龄为78.6岁。在1年的时间里,再次到急诊科就诊的患者比例不断增加,从3天时的2%到1年时的25%。死亡率从3天时的1.2%上升到1年时的15%。在我们7年的研究期间,共有10728名患者(50.2%)在某个时间点返回急诊科,36%的患者在1年内再次急诊就诊或死亡。在多因素逻辑回归分析中,男性和合并症与急诊再次就诊和死亡有关。

结论

超过三分之一的老年急诊跌倒患者在1年内再次急诊就诊或死亡。跌倒是导致频繁急诊就诊和死亡率上升的老年综合征之一。未来的研究应确定跌倒是否会增加此类后果的风险,以及如何预防未来的跌倒和死亡。

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