近期阿片类药物使用与创伤老年患者跌倒相关损伤。

Recent opioid use and fall-related injury among older patients with trauma.

机构信息

Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que.

出版信息

CMAJ. 2018 Apr 23;190(16):E500-E506. doi: 10.1503/cmaj.171286.

DOI:10.1503/cmaj.171286

PMID:29685910

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5915247/

Abstract

BACKGROUND

Evidence for an association between opioid use and risk of falls or fractures in older adults is inconsistent. We examine the association between recent opioid use and the risk, as well as the clinical outcomes, of fall-related injuries in a large trauma population of older adults.

METHODS

In a retrospective, observational, multicentre cohort study conducted on registry data, we included all patients aged 65 years and older who were admitted (hospital stay > 2 d) for injury in 57 trauma centres in the province of Quebec, Canada, between 2004 and 2014. We looked at opioid prescriptions filled in the 2 weeks preceding the trauma in patients who sustained a fall, compared with those who sustained an injury through another mechanism.

RESULTS

A total of 67 929 patients were retained for analysis. Mean age was 80.9 (± 8.0) years and 69% were women. The percentage of patients who had filled an opioid prescription in the 2 weeks preceding an injury was 4.9% (95% confidence interval [CI] 4.7%-5.1%) for patients who had had a fall, compared with 1.5% (95% CI 1.2%-1.8%) for those who had had an injury through another mechanism. After we controlled for confounding variables, patients who had filled an opioid prescription within 2 weeks before injury were 2.4 times more likely to have a fall rather than any other type of injury. For patients who had a fall-related injury, those who used opioids were at increased risk of in-hospital death (odds ratio 1.58; 95% CI 1.34-1.86).

INTERPRETATION

Recent opioid use is associated with an increased risk of fall and an increased likelihood of death in older adults.

摘要

背景

阿片类药物使用与老年人跌倒或骨折风险之间的关联证据并不一致。我们研究了在一个较大的老年创伤人群中，近期阿片类药物使用与跌倒相关损伤的风险以及临床结局之间的关系。

方法

在一项回顾性、观察性、多中心队列研究中，我们纳入了 2004 年至 2014 年期间加拿大魁北克省 57 个创伤中心因伤住院（住院时间>2 天）的所有 65 岁及以上患者。我们观察了在因跌倒受伤的患者中，在创伤前 2 周内开具的阿片类药物处方与因其他机制受伤的患者相比的情况。

结果

共纳入 67929 例患者进行分析。平均年龄为 80.9（±8.0）岁，69%为女性。在创伤前 2 周内开具阿片类药物处方的患者中，因跌倒受伤的患者占 4.9%（95%置信区间 [CI] 4.7%-5.1%），而因其他机制受伤的患者占 1.5%（95% CI 1.2%-1.8%）。在控制混杂变量后，受伤前 2 周内开具阿片类药物处方的患者发生跌倒的可能性是其他类型损伤的 2.4 倍。对于跌倒相关损伤的患者，使用阿片类药物的患者住院死亡风险增加（比值比 1.58；95%CI 1.34-1.86）。