Fletcher Brian, Bradburn Eric, Baker Christopher, Collier Bryan, Hamill Mark, Shaver Katherine
Am Surg. 2017 Jun 1;83(6):559-563.
The Functional Independence Measure (FIM) is used by rehabilitation professionals to access disability. The FIM score combines both motor and cognitive parameters to assess a patient's level of required assistance in performing activities of daily living (ADL). The geriatric trauma patient is becoming an increasingly important cohort for trauma services. FIM has been shown to predict discharge outcomes and those at high risk for falls. We hypothesized pretrauma FIM scores may predict survival in the geriatric trauma population. This was a retrospective study of patients 65 years and older that were admitted to our Level I trauma center from July 1, 2006 to July 1, 2012. A total 941 patients underwent stepwise regression to identify those factors predicting survival. Age, Injury Severity Score, revised trauma score, body mass index, and pretrauma FIM scores (12-point scale) were studied. The primary outcome was survival. Statistical significance reached at P value <0.05. Multiple logistic regression analysis was then performed. A total of 1315 patients were identified and complete data were available on 941 patients. Mean age was 78 (SD ± 8.2), mean Injury Severity Score was 13(SD ± 8.7), and mean body mass index was 26. Overall mortality was 11 per cent. The odds ratio of survival was 3.532 (95% confidence interval = 2.191-5.718) times greater for every 1-point increase in the preadmission FIM expression score. Glasgow Coma Scale, revised trauma score, gender, and pretrauma FIM expression scores were predictive of survival in the geriatric trauma patient. Pretrauma FIM expression can be used to predict survival in the elderly trauma victim. Further study is needed to establish the role of FIM as part of trauma scoring systems.
功能独立性测量（FIM）被康复专业人员用于评估残疾情况。FIM评分结合了运动和认知参数，以评估患者在进行日常生活活动（ADL）时所需的协助水平。老年创伤患者正成为创伤服务中日益重要的一个群体。FIM已被证明可预测出院结果以及跌倒高风险人群。我们假设创伤前FIM评分可能预测老年创伤人群的生存率。这是一项对2006年7月1日至2012年7月1日入住我们一级创伤中心的65岁及以上患者的回顾性研究。总共941名患者接受了逐步回归分析，以确定那些预测生存的因素。研究了年龄、损伤严重程度评分、修订创伤评分、体重指数和创伤前FIM评分（12分制）。主要结局是生存。P值<0.05时具有统计学意义。然后进行了多因素逻辑回归分析。共识别出1315名患者，941名患者有完整数据。平均年龄为78岁（标准差±8.2），平均损伤严重程度评分为13分（标准差±8.7），平均体重指数为26。总体死亡率为11%。入院前FIM表达评分每增加1分，生存的优势比为3.532（95%置信区间=2.191 - 5.718）倍。格拉斯哥昏迷量表、修订创伤评分、性别和创伤前FIM表达评分可预测老年创伤患者的生存情况。创伤前FIM表达可用于预测老年创伤受害者的生存情况。需要进一步研究以确定FIM作为创伤评分系统一部分的作用。
