Crandall Marie, Duncan Thomas, Mallat Ali, Greene Wendy, Violano Pina, Christmas A Britton, Barraco Robert
From the Eastern Association for the Surgery of Trauma Injury Control and Violence Prevention Committee and Practice Management Guidelines Section, Department of Surgery (M.C.), University of Florida Jacksonville, Jacksonville, FL; Department of Surgery (T.D.), Ventura County Medical Center, Ventura, CA, Department of Surgery (A.M.), University of Michigan, Ann Arbor, MI; Department of Surgery (W.G.), Howard University Hospital, Washington, DC; Department of Surgery (P.V.), Yale-New Haven Hospital, New Haven, CT, Department of Surgery (A.B.C.), Carolinas Healthcare Systems, Charlotte, NC; and Department of Surgery (R.B.), Lehigh Valley Health Network, Allentown, PA.
J Trauma Acute Care Surg. 2016 Jul;81(1):196-206. doi: 10.1097/TA.0000000000001025.
Fall-related injuries among the elderly (age 65 and older) are the cause of nearly 750,000 hospitalizations and 25,000 deaths per year in the United States, yet prevention research is lagging. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, the Eastern Association for the Surgery of Trauma produced this practice management guideline to answer the following injury prevention-related population, intervention, comparator, outcomes (PICO) questions:PICO 1: Should bone mineral-enhancing agents be used to prevent fall-related injuries in the elderly?PICO 2: Should hip protectors be used to prevent fall-related injuries in the elderly?PICO 3: Should exercise programs be used to prevent fall-related injuries in the elderly?PICO 4: Should physical environment modifications be used to prevent fall-related injuries in the elderly?PICO 5: Should risk factor screening be used to prevent fall-related injuries in the elderly?PICO 6: Should multiple interventions tailored to the population or individual be used to prevent fall-related injuries in the elderly?
A comprehensive search and review of all the available literature was performed. We used the GRADE methodology to assess the breadth and quality of the data specific to our PICO questions.
We reviewed 50 articles that met our inclusion and exclusion criteria as they applied to our PICO questions.
Given the data constraints, we offer the following suggestions and recommendations:PICO 1: We conditionally recommend vitamin D and calcium supplementation for frail elderly individuals.PICO 2: We conditionally recommend hip protectors for frail elderly individuals, in the appropriate environment.PICO 3: We conditionally recommend evidence-based exercise programs for frail elderly individuals.PICO 4: We conditionally recommend physical environment modification for frail elderly people.PICO 5: We conditionally recommend frailty screening for the elderly.PICO 6: We strongly recommend risk stratification with targeted comprehensive risk-reduction strategies tailored to particular high-risk groups.
Systematic review, level III.
在美国，65岁及以上老年人因跌倒相关损伤每年导致近75万例住院治疗和2.5万例死亡，但预防研究滞后。东部创伤外科学会采用推荐分级的评估、制定和评价（GRADE）方法，制定了本实践管理指南，以回答以下与损伤预防相关的人群、干预措施、对照、结局（PICO）问题：
PICO 1：是否应使用骨矿物质强化剂预防老年人跌倒相关损伤？
PICO 2：是否应使用髋部保护器预防老年人跌倒相关损伤？
PICO 3：是否应使用运动项目预防老年人跌倒相关损伤？
PICO 4：是否应通过改善物理环境预防老年人跌倒相关损伤？
PICO 5：是否应进行风险因素筛查以预防老年人跌倒相关损伤？
PICO 6：是否应采用针对人群或个体的多种干预措施预防老年人跌倒相关损伤？
对所有可用文献进行了全面检索和综述。我们使用GRADE方法评估特定于我们PICO问题的数据广度和质量。
我们审查了50篇符合我们纳入和排除标准且适用于我们PICO问题的文章。
鉴于数据限制，我们提出以下建议：
PICO 1：我们有条件地建议为体弱的老年人补充维生素D和钙。
PICO 2：我们有条件地建议在适当环境中为体弱的老年人使用髋部保护器。
PICO 3：我们有条件地建议为体弱的老年人提供循证运动项目。
PICO 4：我们有条件地建议为体弱的老年人改善物理环境。
PICO 5：我们有条件地建议对老年人进行体弱筛查。
PICO 6：我们强烈建议对特定高危群体进行风险分层，并采用针对性的全面风险降低策略。
系统评价，III级。
