Joseph Bellal, Orouji Jokar Tahereh, Hassan Ahmed, Azim Asad, Mohler Martha Jane, Kulvatunyou Narong, Siddiqi Shirin, Phelan Herb, Fain Mindy, Rhee Peter
From the Division of Trauma, Department of Surgery, (B.J., T.O.J., A.H., A.A., N.K., S.S., P.R.), Critical Care, Burns, and Acute Care Surgery, Arizona Center on Aging, Section of Geriatrics, General Medicine and Palliative Care (M.J.M., M.F.), University of Arizona Medical Center Tucson, Arizona; Division of Trauma, Department of Surgery, Critical Care, Burns, and Acute Care Surgery (H.P.), University of Texas Southwestern Medical Center, Dallas, Texas.
J Trauma Acute Care Surg. 2017 Mar;82(3):575-581. doi: 10.1097/TA.0000000000001329.
Frailty syndrome (FS) is a well-established predictor of outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and to determine its association with trauma readmissions, repeat falls, and mortality at 6 months.
we performed a 2-year (2012-2013) prospective cohort analysis of all consecutive geriatric (age, ≥ 65 years) trauma patients. FS was assessed using a Trauma-Specific Frailty Index (TSFI). Patients were stratified into: nonfrail, TSFI ≤ 0.12; prefrail, TSFI = 0.1 to 0.27; and frail, TSFI > 0.27. Patient follow-up occurred at 6 months to assess outcomes. Regression analysis was performed to assess independent associations between TSFI and outcomes.
Three hundred fifty patients were enrolled. Frail patients were more likely to develop in-hospital complications (nonfrail, 12%; prefrail, 17.4%; and frail, 33.4%; p = 0.02) and an adverse discharge disposition compared with nonfrail and prefrail (nonfrail, 8%; prefrail,18%; and frail, 47%; p = 0.001). Six-month follow-up was recorded in 80% of the patients. Compared with nonfrail patients, frail patients were more likely to have had a trauma-related readmission (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-3.6) and/or repeated falls (OR, 1.6; 95%CI, 1.1-2.5) over the 6-month period. Overall 6-month mortality was 2.8% (n = 10), and frail elderly patients were more likely to have died (OR, 1.1; 95% CI, 1.04-4.7) compared with nonfrail patients.
Over a third of geriatric trauma patients had FS. TSFI provides a practical and accurate assessment tool for identifying elderly trauma patients who are at increased risk of both short-term and long-term outcomes. Early focused intervention in frail geriatric patients is warranted to improve long-term outcomes.
Prognostic study, level II.
衰弱综合征（FS）是老年患者预后的一个公认预测指标。本研究的目的是量化老年创伤患者中FS的患病率，并确定其与创伤再入院、再次跌倒以及6个月时死亡率的关联。
我们对所有连续的老年（年龄≥65岁）创伤患者进行了为期2年（2012 - 2013年）的前瞻性队列分析。使用创伤特异性衰弱指数（TSFI）评估FS。患者被分为：非衰弱，TSFI≤0.12；衰弱前期，TSFI = 0.1至0.27；以及衰弱，TSFI>0.27。在6个月时对患者进行随访以评估预后。进行回归分析以评估TSFI与预后之间的独立关联。
共纳入350例患者。与非衰弱和衰弱前期患者相比，衰弱患者更易发生院内并发症（非衰弱患者为12%；衰弱前期患者为17.4%；衰弱患者为33.4%；p = 0.02）以及不良出院转归（非衰弱患者为8%；衰弱前期患者为18%；衰弱患者为47%；p = 0.001）。80%的患者进行了6个月的随访。与非衰弱患者相比，衰弱患者在6个月期间更易发生创伤相关再入院（比值比[OR]，1.4；95%置信区间[CI]，1.2 - 3.6）和/或再次跌倒（OR，1.6；95%CI，1.1 - 2.5）。6个月时的总体死亡率为2.8%（n = 10），与非衰弱患者相比，衰弱老年患者死亡的可能性更大（OR，1.1；95%CI，1.04 - 4.7）。
超过三分之一的老年创伤患者患有FS。TSFI为识别短期和长期预后风险增加的老年创伤患者提供了一种实用且准确的评估工具。有必要对衰弱老年患者进行早期针对性干预以改善长期预后。
预后研究，二级。
