衰弱对老年创伤患者抢救失败的影响：一项前瞻性研究。
The impact of frailty on failure-to-rescue in geriatric trauma patients: A prospective study.
作者信息
Joseph Bellal, Phelan Herb, Hassan Ahmed, Orouji Jokar Tahereh, O'Keeffe Terence, Azim Asad, Gries Lynn, Kulvatunyou Narong, Latifi Rifat, Rhee Peter
机构信息
From the Department of Surgery (B.J., A.H., T.O.J., T.O.K., A.A., L.G., N.K., R.L., P.R.), Division of Trauma, Critical Care, Burns and Emergency Surgery, University of Arizona, Tucson, Arizona; and Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery (H.P.), University of Texas Southwestern Medical Center, Dallas, Texas.
出版信息
J Trauma Acute Care Surg. 2016 Dec;81(6):1150-1155. doi: 10.1097/TA.0000000000001250.
INTRODUCTION
Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients.
METHODS
We performed a prospective cohort study of all elderly (age ≥ 65 years) trauma patients presenting at our level one trauma center. Patient's frailty status was calculated utilizing the Trauma Specific Frailty Index (TSFI) within 24 hours of admission. Patients were stratified into non-frail, pre-frail, and frail. FTR was defined as death from a major complication (respiratory, infectious, cardiac, and renal). Binary logistic regression analysis was performed after adjusting for age, gender, injury severity (ISS), and vital parameters to assess the relationship between frailty status and FTR.
RESULTS
A total of 368 elderly trauma patients were evaluated of which 25% (n = 93) were non-frail, 38% (n = 139) pre-frail, and 37% (n = 136) frail. Overall, 30% of the patients developed in-hospital complications; of them, mortality occurred in 26% of the patients (FTR group). In the FTR group, 69% of the patients were frail compared to 17% pre-frail and 14% non-frail (p = 0.002). On multivariate regression analysis for predictors of FTR, frail status was an independent predictor of FTR (OR [95% CI] = 2.67 [1.37-5.20]; p = 0.004). On sensitivity analysis, positive predictive value of TSFI for FTR was 69% and negative predictive value for FTR was 67%.
CONCLUSION
In elderly trauma patients, the presence of frailty increased the odds of FTR almost threefold as compared to non-frail. Although FTR has been considered as an indicator of health care quality, the findings of this study suggest that frailty status independently contributes to FTR. This needs to be considered in the future development of quality metrics, particularly in the case of geriatric trauma patients.
LEVEL OF EVIDENCE
Prognostic study, level II.
引言
未能挽救（FTR）（定义为因严重并发症导致的死亡）被视为创伤患者医院质量的一个指标。然而，虚弱在FTR事件中的作用仍不清楚。我们假设老年虚弱创伤患者的FTR率更高。
方法
我们对所有在我们的一级创伤中心就诊的老年（年龄≥65岁）创伤患者进行了一项前瞻性队列研究。在入院24小时内利用创伤特异性虚弱指数（TSFI）计算患者的虚弱状态。患者被分为非虚弱、虚弱前期和虚弱。FTR定义为因严重并发症（呼吸、感染、心脏和肾脏）导致的死亡。在对年龄、性别、损伤严重程度（ISS）和生命体征进行调整后，进行二元逻辑回归分析，以评估虚弱状态与FTR之间的关系。
结果
总共评估了368例老年创伤患者，其中25%（n = 93）为非虚弱，38%（n = 139）为虚弱前期，37%（n = 136）为虚弱。总体而言，30%的患者发生了院内并发症；其中，26%的患者死亡（FTR组）。在FTR组中，69%的患者为虚弱，而虚弱前期为17%，非虚弱为14%（p = 0.002）。在对FTR预测因素的多变量回归分析中，虚弱状态是FTR的独立预测因素（OR [95% CI] = 2.67 [1.37 - 5.20]；p = 0.004）。在敏感性分析中，TSFI对FTR的阳性预测值为69%，阴性预测值为67%。
结论
在老年创伤患者中，与非虚弱患者相比，虚弱的存在使FTR的几率增加了近三倍。尽管FTR被视为医疗质量的一个指标，但本研究结果表明，虚弱状态独立地导致了FTR。在未来质量指标的制定中需要考虑这一点，特别是在老年创伤患者的情况下。
证据水平
预后研究，二级。
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