Hammer Peter M, Storey Annika C, Bell Teresa, Bayt Demetria, Hockaday Melissa S, Zarzaur Ben L, Feliciano David V, Rozycki Grace S
From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
J Trauma Acute Care Surg. 2016 Jul;81(1):162-7. doi: 10.1097/TA.0000000000001063.
Because of the unique physiology and comorbidities of injured geriatric patients, specific interventions are needed to improve outcomes. The purpose of this study was to assess the effect of a change in triage criteria for injured geriatric patients evaluated at an American College of Surgeons Level I trauma center.
As of October 1, 2013, all injured patients 70 years or older were mandated to have the highest-level trauma activation upon emergency department (ED) arrival regardless of physiology or mechanism of injury. Patients admitted before that date were designated as PRE; those admitted after were designated as POST. The study period was from October 1, 2011, through April 30, 2015. Data collected included demographics, mechanism of injury, hypotension on admission, comorbidities, Injury Severity Score (ISS), ED length of stay (LOS), complications, and mortality. Bivariate and multivariable analyses were used to compare outcomes between the study groups (p < 0.05 was considered significant). χ or Fisher's exact test was used as appropriate for bivariate analyses of categorical variables; patients' ages were compared using the Wilcoxon rank-sum test.
A total of 2,269 patients (mean, 80.63 years; mean ISS, 12.2; PRE, 1,271; POST, 933) were included in the study. On multivariable analysis, increasing age, higher ISS, and hypotension were associated with higher mortality. POST patients were more likely to have an ED LOS of 2 hours or shorter (odds ratio, 1.614; 95% confidence interval, 1.088-2.394) after controlling for hypotension, ISS, and comorbidities. POST mortality significantly decreased (odds ratio, 0.689; 95% confidence interval, 0.484-0.979).
Based on age alone, the focused intervention of a higher level of trauma activation decreased ED LOS and mortality in injured geriatric patients.
Therapeutic/care management study, level IV.
由于老年创伤患者具有独特的生理特点和合并症，需要采取特定干预措施以改善治疗效果。本研究旨在评估美国外科医师学会一级创伤中心对老年创伤患者分诊标准改变所产生的影响。
自2013年10月1日起，所有70岁及以上的创伤患者在急诊科就诊时，无论其生理状况或受伤机制如何，均被要求启动最高级别的创伤救治流程。在该日期之前入院的患者被指定为PRE组；之后入院的患者被指定为POST组。研究期间为2011年10月1日至2015年4月30日。收集的数据包括人口统计学资料、受伤机制、入院时低血压情况、合并症、损伤严重程度评分（ISS）、急诊科住院时间（LOS）、并发症及死亡率。采用双变量和多变量分析比较研究组之间的治疗效果（p<0.05被认为具有统计学意义）。分类变量的双变量分析根据情况采用χ²检验或Fisher精确检验；采用Wilcoxon秩和检验比较患者年龄。
本研究共纳入2269例患者（平均年龄80.63岁；平均ISS为12.2；PRE组1271例，POST组933例）。多变量分析显示，年龄增长、ISS升高和低血压与死亡率升高相关。在控制低血压、ISS和合并症后，POST组患者急诊科住院时间更有可能为2小时或更短（优势比，1.614；95%置信区间，1.088 - 2.394）。POST组死亡率显著降低（优势比，0.689；95%置信区间，0.484 - 0.979）。
仅基于年龄，更高水平创伤救治流程的针对性干预降低了老年创伤患者的急诊科住院时间和死亡率。
治疗/护理管理研究，IV级。
