Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States.
Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States.
Injury. 2022 Nov;53(11):3723-3728. doi: 10.1016/j.injury.2022.08.048. Epub 2022 Aug 24.
Ground-level falls (GLFs) in older adults are increasing as life expectancy increases, and more patients are being discharged to skilled nursing facilities (SNFs) for continuity of care. However, GLF patients are not a homogenous cohort, and the role of frailty remains to be assessed. Thus, the aim of this study is to examine the impact of frailty on the in-hospital and 30-day outcomes of GLF patients.
This is a cohort analysis from the Nationwide Readmissions Database 2017. Geriatric (age ≥65 years) trauma patients presenting following GLFs were identified and grouped based on their frailty status. The associations between frailty and 30-day mortality and emergency readmission were examined by multivariate regression analyses adjusting for patient demographics and injury characteristics.
A total of 100,850 geriatric GLF patients were identified (frail: 41% vs. non-frail: 59%). Frail GLF patients were younger (81[74-87] vs. 83[76-89] years; p<0.001) and less severely injured-Injury Severity Score [ISS] (4[1-9] vs. 5[2-9]; p<0.001). Frail patients had a higher index mortality (2.9% vs. 1.9%; p<0.001) and higher 30-day readmissions (14.0% vs. 9.8%; p<0.001). Readmission mortality was also higher in the frail group (15.2% vs. 10.9%; p<0.001), with 75.2% of those patients readmitted from an SNF. On multivariate analysis, frailty was associated with 30-day mortality (OR 1.75; p<0.001) and 30-day readmission (OR 1.49; p<0.001).
Frail geriatric patients are at 75% higher odds of mortality and 49% higher odds of readmission following GLFs. Of those readmitted on an emergency basis, more than one in seven patients died, 75% of whom were readmitted from an SNF. This underscores the need for optimization plans that extend to the post-discharge period to reduce readmissions and subsequent high-impact consequences.
随着预期寿命的延长，老年人的地面水平跌倒（GLF）越来越多，更多的患者被送往熟练护理机构（SNF）以保持护理的连续性。然而，GLF 患者并不是一个同质的队列，虚弱的作用仍有待评估。因此，本研究旨在探讨虚弱对 GLF 患者住院期间和 30 天结局的影响。
这是 2017 年全国再入院数据库的队列分析。确定了因 GLF 而出现的年龄在 65 岁及以上的老年创伤患者，并根据其虚弱状况进行分组。通过多变量回归分析，调整患者人口统计学和损伤特征，检查虚弱与 30 天死亡率和急诊再入院之间的关联。
共确定了 100850 名老年 GLF 患者（虚弱：41% vs. 非虚弱：59%）。虚弱的 GLF 患者更年轻（81[74-87] 岁 vs. 83[76-89] 岁；p<0.001），受伤程度较轻-损伤严重程度评分（ISS）（4[1-9] vs. 5[2-9]；p<0.001）。虚弱患者的指数死亡率更高（2.9% vs. 1.9%；p<0.001），30 天再入院率更高（14.0% vs. 9.8%；p<0.001）。虚弱组的再入院死亡率也更高（15.2% vs. 10.9%；p<0.001），其中 75.2%的患者从 SNF 再入院。多变量分析显示，虚弱与 30 天死亡率（OR 1.75；p<0.001）和 30 天再入院（OR 1.49；p<0.001）相关。
虚弱的老年患者 GLF 后死亡的可能性高 75%，再入院的可能性高 49%。在紧急情况下再入院的患者中，超过七分之一的患者死亡，其中 75%是从 SNF 再入院的。这凸显了需要制定优化计划，将其延伸到出院后阶段，以减少再入院和随后的高影响后果。
