Pierrie Sarah N, Wally Meghan K, Churchill Christine, Patt Joshua C, Seymour Rachel B, Karunakar Madhav A
Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.
Geriatr Orthop Surg Rehabil. 2019 Jun 10;10:2151459319856230. doi: 10.1177/2151459319856230. eCollection 2019.
The purpose of this study is to examine utilization of acute care services in the year prior to hip fracture to inform development and implementation of an intervention to prevent subsequent falls and hip fracture that targets high-risk patients.
Elderly patients (age >55) with hip fractures managed at a level one trauma center during 1 year (n = 134) were included. All "preadmissions," defined as an emergency department (ED) visit or inpatient admission within our hospital system in the year before fall with fracture, were documented. Proportion of patients with a "preadmission," reason for "preadmission," demographic characteristics, medical comorbidities, history of falls with fracture, cause of fracture, and time between preadmission and fracture were documented and described.
Of all, 45.5% of patients (n = 61) had a preadmission. Falls was the reason for presentation in 27.5% of the preadmission encounters, and the median interval between preadmission and fracture was 217 days. Only 8% of the patients presenting for falls in the ED received falls counseling. Patients who experienced preadmission were younger, had a higher Charlson Comorbidity Index, and were more likely to be male. Seventy-nine percent were community dwelling at the time of preadmission, and 68% were discharged home.
Nearly half of hip fracture patients were seen in a high acuity care environment in the year prior to fracture. A quarter presented for falls, supporting previous findings that history of falls is an important risk factor for future falls and injury. However, very few received falls counseling, documenting a major missed opportunity to address falls prevention in the acute care setting.
Preventing subsequent falls and hip fractures in a targeted, high-risk population in the year prior to potential hip fracture has important implications for improving individual morbidity and mortality and population health. Community-based falls prevention programs are a viable option for this high-risk, community-dwelling population. Collaborative interventions are needed to actively link patients to evidence-based community resources.
本研究的目的是调查髋部骨折前一年急性护理服务的利用情况，为针对高危患者预防后续跌倒和髋部骨折的干预措施的制定和实施提供信息。
纳入在一级创伤中心接受治疗的134例髋部骨折老年患者（年龄>55岁）。记录所有“入院前就诊”情况，定义为在跌倒并骨折前一年内在我院系统内的急诊科就诊或住院。记录并描述有“入院前就诊”的患者比例、“入院前就诊”原因、人口统计学特征、合并症、跌倒并骨折史、骨折原因以及入院前就诊与骨折之间的时间间隔。
总体而言，45.5%的患者（n = 61）有入院前就诊情况。跌倒占入院前就诊情况的27.5%，入院前就诊与骨折之间的中位间隔为217天。在急诊科因跌倒就诊的患者中，只有8%接受了跌倒咨询。有入院前就诊情况的患者更年轻，Charlson合并症指数更高，且男性居多。79%的患者在入院前居住在社区，68%出院回家。
近一半的髋部骨折患者在骨折前一年曾在高急症护理环境中就诊。四分之一的患者因跌倒就诊，这支持了先前的研究结果，即跌倒史是未来跌倒和受伤的重要危险因素。然而，很少有患者接受跌倒咨询，这表明在急性护理环境中存在预防跌倒的重大错失机会。
在潜在髋部骨折前一年，针对高危人群预防后续跌倒和髋部骨折，对于改善个体发病率和死亡率以及人群健康具有重要意义。基于社区的跌倒预防计划对于这一高危、居住在社区的人群是一个可行的选择。需要采取协作干预措施，积极将患者与基于证据的社区资源联系起来。
