Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Emergency Medicine Department, National University Hospital, National University Health System, Singapore.
Injury. 2022 Oct;53(10):3149-3155. doi: 10.1016/j.injury.2022.08.018. Epub 2022 Aug 8.
An ageing population has caused rising trauma cases amongst older patients. Multiple comorbidities, polypharmacy and limited reserves predispose them to poorer outcomes following a traumatic event. The Comorbidity Polypharmacy Score (CPS) has been found to predict outcomes and mortality in older trauma patients, but has not been studied in Asians.
We aim to describe the epidemiological characteristics of older trauma patients and explore the association of CPS on clinical outcomes.
We conducted a retrospective observational study using data from the trauma registries of 2 tertiary trauma centres. Patients aged 45 years and above attending the emergency departments (EDs) from January 2011 to December 2015 with traumatic injuries (Injury Severity Score [ISS] of 9 and above) were included. Demographics, clinical data including number of comorbidities and medications used were collected to calculate the CPS. Outcomes of mortality, ED disposition and hospital discharge venue were examined.
There were 4,522 patients (median age 70 years; males 53.8%), with majority sustaining Tier 2 injuries (ISS 9 to 15; 68.9%). Falls were the predominant mechanism for those aged above 60 years and above (76%). Median CPS was 6 (interquartile range [IQR] 1 to 11). Amongst patients 75 years and older, 56% comprised the moderate to morbid CPS groups (CPS ≥ 8). Overall mortality was 8.4%; patients above 75 years had longer median length of stay (10 versus 7.1-8.9 days in other ages). Male gender (adjusted odds ratio [aOR] 1.51; 95% confidence interval [CI] 1.12-2.02), increasing age (aOR 1.04; 95% CI 1.03-1.05), injury to abdomen (aOR 3.24; 95% CI 1.93-5.45) and severe CPS category (aOR 1.88; 95% CI 1.23-2.89) were associated with increased odds of death. Increasing age and moderate CPS category increased odds of discharge to a rehabilitation (aOR for age 1.03, 95% CI 1.02-1.04; aOR for moderate CPS 1.72, 95% CI 1.43-2.07) or long-term care facility (aOR for age 1.05, 95% CI 1.03-1.06; aOR for CPS 1.60, 95% CI 1.10-2.32).
CPS predicted mortality and discharge to a rehabilitation or care facility in this urban, ageing Asian population. Its use may aid future trauma research and needs assessments in such patients.
人口老龄化导致老年创伤患者的创伤病例不断增加。多种合并症、多种药物治疗和储备能力有限，使他们在创伤后更有可能出现不良后果。合并症和药物使用评分（CPS）已被证明可预测老年创伤患者的结局和死亡率，但尚未在亚洲人群中进行研究。
我们旨在描述老年创伤患者的流行病学特征，并探讨 CPS 对临床结局的关联。
我们使用 2 家三级创伤中心的创伤登记处的数据进行了回顾性观察性研究。纳入年龄 45 岁及以上、因创伤性损伤（损伤严重度评分 [ISS]≥9 分）到急诊科就诊的患者。收集人口统计学数据、临床数据，包括合并症数量和使用的药物，以计算 CPS。检查死亡率、急诊科处置和医院出院去向的结局。
共有 4522 例患者（中位数年龄 70 岁；男性占 53.8%），大多数患者为二级损伤（ISS 9 至 15 分；68.9%）。60 岁以上患者以跌倒为主要致伤机制（76%）。中位 CPS 为 6（四分位距 [IQR] 1 至 11）。75 岁及以上患者中，56%为中重度 CPS 组（CPS≥8）。总体死亡率为 8.4%；75 岁以上患者的中位住院时间更长（10 天 vs 其他年龄组的 7.1-8.9 天）。男性（调整优势比 [aOR] 1.51；95%置信区间 [CI] 1.12-2.02）、年龄增长（aOR 1.04；95%CI 1.03-1.05）、腹部损伤（aOR 3.24；95%CI 1.93-5.45）和严重 CPS 类别（aOR 1.88；95%CI 1.23-2.89）与死亡风险增加相关。年龄增长和中度 CPS 类别增加了康复（aOR 年龄 1.03，95%CI 1.02-1.04；中度 CPS aOR 1.72，95%CI 1.43-2.07）或长期护理机构（aOR 年龄 1.05，95%CI 1.03-1.06；CPS 1.60，95%CI 1.10-2.32）出院的几率。
在这个城市老龄化的亚洲人群中，CPS 预测死亡率和康复或护理机构的出院。它的使用可能有助于未来在这些患者中的创伤研究和需求评估。
