Dingley Stephen D, Bauerle Wayne B, Ramirez Christine, Weber Holly, Wilde-Onia Rebecca, Szoke Ann-Marie, Benton Adam, Frutiger Danielle, Mira Alaa-Eldin, Hoff William, Stawicki Stanislaw P
Department of Surgery, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA.
Department of Surgery and Research & Innovation, Level I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA.
J Emerg Trauma Shock. 2022 Apr-Jun;15(2):93-98. doi: 10.4103/jets.jets_19_22. Epub 2022 Jun 27.
Geriatric trauma patients (GTP) make up an increasing percentage of the overall trauma population. Due to frailty, GTP are at an increased risk of morbidity and readmission. Therefore, it is becoming increasingly important to prognosticate outcomes to assist with resource utilization. We hypothesized that the "Identification of Seniors at Risk" (ISAR) score may correlate with both clinical outcomes and resource utilization for geriatric trauma patients.
Patients older than 65 years who were admitted to the trauma service were screened using an ISAR scoring algorithm. Outcomes, including 30-day mortality, all-cause morbidity, hospital length of stay (LOS), intensive care unit (ICU) LOS, functional independence measures (FIM) at discharge, and percent discharged to a facility, were analyzed. Both descriptive and data-appropriate parametric and non-parametric statistical approaches were utilized, with significance set at α = 0.05.
One thousand and two hundred seventeen GTP were included in this study. The average age was 81, median injury severity score was 9, and 99% had a blunt trauma mechanism. ISAR scores were generally associated with increasing 30-day mortality (0%, 1.9%, 2.4%, and 2.1% for ISAR 0, ISAR 1-2, ISAR 3-4, and ISAR 5-6, respectively), morbidity (2.6%, 7.6%, 14.7%, and 7.3% for respective categories), longer hospital (3.1, 4.6, 5.1, and 4.3 days, respectively) and ICU stays (0.37, 0.64, 0.81, and 0.67, respectively), lower FIM score at discharge (18.5, 17.1, 15.8, and 14.4, for respective categories), as well as increasing percentage of patients discharged to a facility (29.8%, 58.9%, 72.1%, and 78.8% for respective categories).
This exploratory study provides important early insight into potential relationships between ISAR and geriatric trauma outcomes. ISAR screening is a quick and easy-to-use tool that may be useful in GTP triage, level-of-care determination, and disposition planning. Understanding populations at risk, especially those with more intricate discharge needs, is an important step in mitigating those risks and implementing appropriate care plans.
老年创伤患者（GTP）在总体创伤人群中所占比例日益增加。由于身体虚弱，老年创伤患者发病和再入院的风险增加。因此，预测预后对于协助资源利用变得越来越重要。我们假设“识别高危老年人”（ISAR）评分可能与老年创伤患者的临床结局和资源利用相关。
使用ISAR评分算法对入住创伤科的65岁以上患者进行筛查。分析了包括30天死亡率、全因发病率、住院时间（LOS）、重症监护病房（ICU）住院时间、出院时的功能独立性测量（FIM）以及转至医疗机构的出院患者百分比等结局指标。采用了描述性以及适用于数据的参数和非参数统计方法，显著性设定为α = 0.05。
本研究纳入了1217例老年创伤患者。平均年龄为81岁，中位损伤严重程度评分为9分，99%的患者为钝性创伤机制。ISAR评分通常与30天死亡率增加相关（ISAR 0、ISAR 1 - 2、ISAR 3 - 4和ISAR 5 - 6组分别为0%、1.9%、2.4%和2.1%）、发病率增加（相应类别分别为2.6%、7.6%、14.7%和7.3%）、住院时间延长（分别为3.1天、4.6天、5.1天和4.3天）以及ICU住院时间延长（分别为0.37天、0.64天、0.81天和0.67天）、出院时FIM评分降低（相应类别分别为18.5、17.1、15.8和14.4），以及转至医疗机构的出院患者百分比增加（相应类别分别为29.8%、58.9%、72.1%和78.8%）。
这项探索性研究为ISAR与老年创伤结局之间的潜在关系提供了重要的早期见解。ISAR筛查是一种快速且易于使用的工具，可能有助于老年创伤患者的分诊、护理级别确定和处置计划制定。了解高危人群，尤其是那些出院需求更为复杂的人群，是降低这些风险并实施适当护理计划的重要一步。
