Department of Surgery, Marshall University, Huntington, West Virginia.
Department of Surgery, Marshall University, Huntington, West Virginia.
J Surg Res. 2019 Jan;233:391-396. doi: 10.1016/j.jss.2018.08.037. Epub 2018 Sep 14.
Blunt trauma in the geriatric population is fraught with poor outcomes, with injury severity and comorbidities impacting morbidity and mortality.
We retrospectively reviewed 2172 patients aged ≥65 y who fell, requiring hospital admission between January 2012 and December 2016. There were 403 patients in the surgical arm (SA) and 1769 patients in the medical arm (MA). Ground-level falls were the only mechanism of injury included. We excluded all ICU admissions and deaths within 24 h.
There were 5 deaths (1.24%) in the SA and 16 deaths (0.90%) in the MA (P = 0.57). The mean trauma injury severity score survival probability prediction in the SA was 96.9% versus 97.1% in the MA. MA patients had more comorbidities overall than SA patients. There was no difference in mortality between the SA and MA groups in multiple logistic regression models that accounted for trauma injury severity scores (TRISS) and comorbidities. Unadjusted hospital length of stay was 1 d shorter (median; 95% CI -1.4 to -0.6) in the SA and 0.5 d shorter (median; 95% CI -0.8 to -0.1) when adjusted for TRISS and comorbidities using multiple quantile regression. Finally, patients in the SA were 2.1 (95% CI 1.7 to 2.6) times more likely to be discharged home compared with patients in the MA, and this remained significant (OR 1.9; 95% CI 1.5 to 2.5) with simultaneous adjustment for TRISS and comorbidities using multiple logistic regression.
Geriatric blunt trauma patients admitted to surgical services after mechanical falls have no difference in survival, a shorter median length of stay, and increased likelihood of being discharged home compared with patients admitted to medical services.
老年人钝性创伤的预后较差，受伤严重程度和合并症会影响发病率和死亡率。
我们回顾性分析了 2012 年 1 月至 2016 年 12 月间因摔倒需要住院的 2172 名年龄≥65 岁的患者。其中手术组（SA）有 403 例，医疗组（MA）有 1769 例。只包括地面坠落这一单一损伤机制。我们排除了所有 ICU 住院和 24 小时内死亡的患者。
SA 组有 5 例死亡（1.24%），MA 组有 16 例死亡（0.90%）（P=0.57）。SA 组创伤严重程度评分生存概率预测平均为 96.9%，MA 组为 97.1%。与 SA 组相比，MA 组患者的合并症总体更多。多变量逻辑回归模型在考虑创伤严重程度评分（TRISS）和合并症后，SA 和 MA 两组之间的死亡率没有差异。未调整的住院时间在 SA 组缩短 1 天（中位数；95%CI -1.4 至 -0.6），在调整 TRISS 和合并症的情况下缩短 0.5 天（中位数；95%CI -0.8 至 -0.1）。使用多元分位数回归。最后，与 MA 组相比，SA 组患者出院回家的可能性高 2.1 倍（95%CI 1.7 至 2.6），并且在使用多变量逻辑回归同时调整 TRISS 和合并症后，这一结果仍然显著（OR 1.9；95%CI 1.5 至 2.5）。
与接受医疗服务的患者相比，因机械性摔倒而接受外科治疗的老年钝性创伤患者在存活率、中位住院时间较短以及出院回家的可能性增加方面没有差异。
