Gerrish Ashley W, Hamill Mark E, Love Katie M, Lollar Daniel I, Locklear Tonja M, Dhiman Nitasha, Nussbaum Michael S, Collier Bryan R
Am Surg. 2018 Aug 1;84(8):1272-1276.
Geriatric trauma patients with low-level falls often have multiple comorbidities and limited physiologic reserve. Our aim was to investigate postdischarge mortality in this population. We hypothesized that five-year mortality would be higher relative to other blunt mechanisms. The registry of our Level 1 trauma center was queried for patients evaluated between July 2008 and December 2012. Adult patients identified were matched with mortality data from 2008 to 2013 from the National Death Index. Low-level falls were identified by E Codes; other types of blunt trauma were based on registry classification. Patients with multiple admissions were excluded. Univariate analysis was performed using Fisher's exact and Wilcoxon tests. Kaplan-Meier curves were plotted to compare postdischarge mortality. Seven thousand nine hundred sixteen patients were evaluated, 35.1 per cent were females. Patients aged less than 65 years and penetrating trauma were excluded, yielding 1997 patients-63.7 per cent with low-level falls versus 36.3 per cent with other blunt traumas. Geriatric patients sustaining low-level falls were older, more likely female, had a higher inpatient mortality, and were less likely to return home at discharge. Injury severity score, hospital length of stay, and intensive care unit length of stay were similar. Survival analysis demonstrated increased postdischarge mortality in the low-level fall group with 25 per cent mortality at 120 days. Geriatric patients with other blunt trauma had a significantly lower postdischarge mortality. Geriatric patients injured in low-level falls have a higher inhospital mortality, are more likely to be functionally dependent on discharge, and have a high postdischarge mortality. Opportunities likely exist for injury prevention, consideration of palliative care, and postdischarge rehabilitation.
老年低水平跌倒创伤患者往往存在多种合并症且生理储备有限。我们的目的是调查该人群出院后的死亡率。我们假设，与其他钝性创伤机制相比，五年死亡率会更高。我们查询了一级创伤中心登记处2008年7月至2012年12月期间评估的患者。确定的成年患者与2008年至2013年国家死亡指数的死亡率数据进行匹配。低水平跌倒通过E编码确定；其他类型的钝性创伤基于登记分类。排除多次入院的患者。使用Fisher精确检验和Wilcoxon检验进行单因素分析。绘制Kaplan-Meier曲线以比较出院后死亡率。共评估了7916例患者，其中35.1%为女性。排除年龄小于65岁的患者和穿透性创伤患者，得到1997例患者，其中63.7%为低水平跌倒患者，36.3%为其他钝性创伤患者。遭受低水平跌倒的老年患者年龄更大，女性可能性更高，住院死亡率更高，出院时回家的可能性更小。损伤严重程度评分、住院时间和重症监护病房住院时间相似。生存分析表明，低水平跌倒组出院后死亡率增加，120天时死亡率为25%。其他钝性创伤的老年患者出院后死亡率显著较低。低水平跌倒受伤的老年患者住院死亡率较高，出院时功能依赖的可能性更大，出院后死亡率也较高。在预防损伤、考虑姑息治疗和出院后康复方面可能存在机会。
