Bobian Michael, El-Kashlan Nour, Hanba Curtis J, Svider Peter F, Folbe Adam J, Eloy Jean Anderson, Zuliani Giancarlo F, Carron Michael
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan2Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 1;143(6):569-573. doi: 10.1001/jamaoto.2016.4275.
As the nursing home population continues to increase, an understanding of preventable injuries becomes exceedingly important. Although other fall-related injuries have been characterized, little attention has been dedicated to facial trauma.
To estimate the incidence of facial trauma among nursing home residents and detail mechanisms of injury, injury characteristics, and patient demographic data.
DESIGN, SETTING, AND PARTICIPANTS: The National Electronic Injury Surveillance System was used to calculate a weighted national incidence of facial trauma among individuals older than 60 years from a nationally representative collection of emergency departments from January 1, 2011, through December 31, 2015. Entries were screened for nursing home residents, and diagnosis, anatomical site, demographic data, and mechanism of injury were analyzed.
There were 109 795 nursing home residents (median age, 84.1 years; interquartile range, 79-89 years; 71 466 women [65.1%]) who required emergency department care for facial trauma. Women sustained a greater proportion of injuries with increasing age. The most common injuries were lacerations (48 679 [44.3%]), other soft-tissue injuries (45 911 [41.8%]; avulsions, contusions, and hematomas), and fractures (13 814 [12.6%]). Nasal (9331 [67.5%]) and orbital (1144 [8.3%]) fractures were the most common sites. The most common injury causes were direct contact with structural housing elements or fixed items (62 604 [57.0%]) and transfer to and from bed (24 870 [22.6%]).
Despite falls being considered a Centers for Medicare & Medicaid Services preventable never event in hospitals, our analysis in the nursing home setting found more than 100 000 facial injuries during 5 years, suggesting these underappreciated injuries contribute substantially to health care expenditures. Although structural elements facilitated the greatest number of falls, transfer to and from bed remains a significant mechanism, suggesting an area for intervention.
随着养老院人口持续增加，了解可预防伤害变得极其重要。尽管已对其他与跌倒相关的伤害进行了特征描述，但对面部创伤关注甚少。
估计养老院居民面部创伤的发生率，并详细说明损伤机制、损伤特征和患者人口统计学数据。
设计、地点和参与者：使用国家电子伤害监测系统，根据2011年1月1日至2015年12月31日全国具有代表性的急诊科收集的数据，计算60岁以上人群面部创伤的加权全国发生率。对记录进行筛查以确定养老院居民，并分析诊断、解剖部位、人口统计学数据和损伤机制。
有109795名养老院居民（中位年龄84.1岁；四分位间距79 - 89岁；71466名女性[65.1%]）因面部创伤需要急诊科护理。随着年龄增长，女性受伤的比例更高。最常见的损伤是撕裂伤（48679例[44.3%]）、其他软组织损伤（45911例[41.8%]；撕脱伤、挫伤和血肿）和骨折（13814例[12.6%]）。鼻骨骨折（9331例[67.5%]）和眼眶骨折（1144例[8.3%]）是最常见的部位。最常见的损伤原因是与建筑结构部件或固定物品直接接触（62604例[57.0%]）以及上下床转移（24870例[22.6%]）。
尽管跌倒在医院被医疗保险和医疗补助服务中心视为可预防的严重不良事件，但我们在养老院环境中的分析发现，5年内有超过10万例面部损伤，这表明这些未得到充分重视的损伤对医疗保健支出有很大影响。尽管建筑结构部件导致的跌倒数量最多，但上下床转移仍是一个重要的损伤机制，提示这是一个可进行干预的领域。
