Department of Trauma and Acute Care Surgery, Eskenazi Health, Indianapolis, IN.
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
J Surg Res. 2021 Oct;266:413-420. doi: 10.1016/j.jss.2021.04.029. Epub 2021 Jun 5.
The purpose of this study was to evaluate the association between pre-injury Katz Index of Independence in Activities of Daily Living (Katz ADL) functional status and discharge to a facility in non-neurologically injured older trauma patients.
Data were obtained from 207 patients in the Trauma Medical Home study cohort. Multivariable logistic regression was performed to identify factors associated with non-home discharge.
Average patient age was 67.9 (SD 11.1). Patients were predominantly white (89.4%) and female (52.2%) with a median ISS of 11 (IQR 9-14). The most common mechanism of injury was fall (48.3%), followed by motor vehicle crash (41.1%). Nearly all patients (94.7%) reported independence in activities of daily living prior to hospitalization for injury. Discharge disposition varied, 51.7% of patients were discharged home, 37.7% to subacute rehabilitation, 10.1% to acute rehabilitation and 0.5% to long-term acute care. There was no relationship between pre-injury independence and likelihood of discharge home (P = 0.1331). Age (P < 0.0001), BMI (P = 0.0002), Charlson comorbidity score of 3 or greater (P = 0.0187), being single (P = 0.0077), ISS ≥ 16 (P = 0.0075) and being female with self-reported symptoms of anxiety and/or depression over the past two weeks (P = 0.0092) were associated with significantly greater odds of non-home discharge.
Pre-injury Katz ADL is not associated with discharge disposition, though other significantly associated factors were identified. It is imperative that discussions regarding discharge disposition are initiated early during acute hospitalization. Trauma programs could potentially benefit from implementing an inpatient intervention focused on building coping skills for older patients exhibiting symptoms of anxiety or depression.
本研究旨在评估受伤前 Katz 日常生活活动（Katz ADL）独立性指数与非神经损伤老年创伤患者出院至医疗机构之间的关联。
数据来自创伤医疗之家研究队列中的 207 名患者。采用多变量逻辑回归分析确定与非家庭出院相关的因素。
患者平均年龄为 67.9（SD 11.1）岁。患者主要为白人（89.4%）和女性（52.2%），ISS 中位数为 11（IQR 9-14）。最常见的损伤机制是跌倒（48.3%），其次是机动车事故（41.1%）。几乎所有患者（94.7%）在因伤住院前报告日常生活活动独立。出院去向各不相同，51.7%的患者出院回家，37.7%的患者出院至亚急性康复，10.1%的患者出院至急性康复，0.5%的患者出院至长期急性护理。受伤前的独立性与出院回家的可能性之间没有关系（P=0.1331）。年龄（P<0.0001）、BMI（P=0.0002）、Charlson 合并症评分≥3（P=0.0187）、单身（P=0.0077）、ISS≥16（P=0.0075）和女性报告过去两周有焦虑和/或抑郁症状（P=0.0092）与非家庭出院的可能性显著增加相关。
受伤前的 Katz ADL 与出院去向无关，但确定了其他显著相关的因素。在急性住院期间尽早开始讨论出院去向至关重要。创伤项目可能受益于实施针对表现出焦虑或抑郁症状的老年患者的住院干预，以建立应对技能。
