From the Department of Surgery, University of Alberta, Edmonton, Alta.
Can J Surg. 2019 Apr 1;62(2):100-104. doi: 10.1503/cjs.017117.
The Beers Criteria for Potentially Inappropriate Medication Use inOlder Adults is a framework that can assess the nature of high-risk medication use. The objective of this study was to use the Beers Criteria to assess the prevalence and nature of polypharmacy, the magnitude of medication changes during the hospital stay and the impact of Beers Criteria medications on outcomes in older patients with trauma.
We used the Alberta Trauma Registry to conduct a retrospective review of patients aged 65 years or older with major trauma (Injury Severity Score ≥ 12) who were admitted to a level 1 trauma centre between January 2013 and December 2014. We analyzed changes in medication prescriptions during the hospital stay using descriptive statistics and assessed the association between Beers Criteria medications and relevant outcomes using multivariable regression analysis.
There was no significant change in the number of Beers Criteria medications prescribed before and after admission. The adjusted odds ratio for 30-day mortality for each additional Beers Criteria medication prescribed was 2.02 (95% confidence interval [CI] 1.16–3.51) versus 1.24 (95% CI 1.04–1.59) for each additional medication of any type. The corresponding adjusted incidence rate ratios for length of stay were 1.15 (95% CI 1.03–1.30) versus 1.05 (95% CI 1.01–1.10).
Beers Criteria medications were not discontinued during trauma admissions. Using the Beers Criteria as a process indicator for quality improvement in trauma care may provide interdisciplinary trauma teams an opportunity to audit patient medications and stop potentially harmful medications in a vulnerable population.
《老年人潜在不适当药物使用的 Beers 标准》是一个可以评估高风险药物使用性质的框架。本研究的目的是使用 Beers 标准评估创伤老年患者的药物使用、药物变化程度以及 Beers 标准药物对结果的影响。
我们使用艾伯塔创伤登记处对 2013 年 1 月至 2014 年 12 月期间入住 1 级创伤中心的年龄在 65 岁或以上、损伤严重程度评分≥12 的严重创伤患者进行回顾性研究。我们使用描述性统计分析了住院期间药物处方的变化，并使用多变量回归分析评估了 Beers 标准药物与相关结果之间的关联。
入院前后开具的 Beers 标准药物数量没有显著变化。与每种其他类型药物相比，每增加一种 Beers 标准药物，30 天死亡率的调整后比值比为 2.02（95%置信区间 [CI] 1.16-3.51），而每种其他类型药物的调整后比值比为 1.24（95%置信区间 [CI] 1.04-1.59）。与每种其他类型药物相比，住院时间的相应调整发病率比为 1.15（95%置信区间 [CI] 1.03-1.30），而每种其他类型药物的调整发病率比为 1.05（95%置信区间 [CI] 1.01-1.10）。
Beers 标准药物在创伤入院期间未被停用。使用 Beers 标准作为创伤护理质量改进的过程指标，可能为跨学科创伤团队提供机会，审核患者的药物并停止弱势人群中潜在的有害药物。
