CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Lancet Healthy Longev. 2022 Aug;3(8):e540-e548. doi: 10.1016/S2666-7568(22)00122-2. Epub 2022 Jul 4.
Older people are the largest group admitted to hospital with serious injuries. Many older people are living with frailty, a risk factor for poor recovery. We aimed to examine the effect of preinjury frailty on outcomes.
In this multicentre observational study (FiTR 1), we extracted prospectively collected data from all 23 adult major trauma centres in England on older people (aged ≥65 years) admitted with serious injuries over a 2·5 year period from the Trauma Audit and Research Network (TARN) database. Geriatricians assessed the preinjury Clinical Frailty Scale (CFS), a 9-point scale of fitness and frailty, with a score of 1 indicating a patient is very fit and a score of 9 indicating they are terminally ill. The primary outcome was inpatient mortality, with patients censored at hospital discharge. We used a multi-level Cox regression model fitted with adjusted hazards ratios (aHRs) to assess the association between CFS and mortality, with CFS scores being grouped as follows: a score of 1-2 indicated patients were fit; a score of 3 indicated patients were managing well; and a score of 4-8 indicated patients were living with frailty (4 being very mild, 5 being mild, 6 being moderate, and 7-8 being severe).
Between March 31, 2019, and Oct 31, 2021, 193 156 patients had records were held by TARN, of whom 16 504 had eligible records. Median age was 81·9 years (IQR 74·7-88·0), 9200 (55·7%) were women, and 7304 (44·3%) were men. Of 16 438 patients with a CFS score of 1-8, 11 114 (67·6%) were living with frailty (CFS of 4-8). 1660 (10·1%) patients died during their hospital stay, with a median time from admission to death of 9 days (IQR 4-18). Compared in patients with a CFS score of 1-2, risk of inpatient death was increased in those managing well (CFS score of 3; aHR 1·82 [95% CI 1·39-2·40]), living with very mild frailty (CFS score of 4: 1·99 [1·51-2·62]), living with mild frailty (CFS score of 5: 2·61 [1·99-3·43]), living with moderate frailty (CFS score of 6: 2·97 [2·26-3·90]), and living with severe frailty (CFS score of 7-8: 4·03 [3·04-5·34]).
Our findings support inclusion of the CFS in trauma pathways to aid patient management. Additionally, people who exercise regularly (CFS of 1-2) have better outcomes than those with lower activity levels (CFS of ≥3), supporting exercise as an intervention to improve trauma outcomes.
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老年人是因严重受伤而住院的最大群体。许多老年人都患有衰弱症，这是恢复不良的一个风险因素。我们旨在研究受伤前衰弱对结果的影响。
在这项多中心观察性研究（FiTR1）中，我们从创伤审核和研究网络（TARN）数据库中提取了 23 家英格兰成年主要创伤中心在 2.5 年期间对严重受伤的老年人（年龄≥65 岁）的前瞻性收集数据。老年病医生评估了受伤前的临床虚弱量表（CFS），这是一个 9 分制的健康和虚弱量表，得分 1 表示患者非常健康，得分 9 表示患者生命垂危。主要结局是住院死亡率，患者在出院时被删失。我们使用多水平 Cox 回归模型拟合调整后的危险比（aHR）来评估 CFS 与死亡率之间的关联，CFS 评分分为以下几类：1-2 分表示患者健康状况良好；3 分表示患者状况良好；4-8 分表示患者患有衰弱症（4 分为非常轻度，5 分为轻度，6 分为中度，7-8 分为重度）。
在 2019 年 3 月 31 日至 2021 年 10 月 31 日期间，TARN 保存了 193156 名患者的记录，其中 16504 名患者的记录符合条件。中位年龄为 81.9 岁（IQR 74.7-88.0），9200 名（55.7%）为女性，7304 名（44.3%）为男性。在 16438 名 CFS 评分为 1-8 的患者中，有 11114 名（67.6%）患有衰弱症（CFS 评分为 4-8）。1660 名（10.1%）患者在住院期间死亡，从入院到死亡的中位时间为 9 天（IQR 4-18）。与 CFS 评分为 1-2 的患者相比，状况良好（CFS 评分为 3；aHR 1.82[1.39-2.40]）、患有非常轻度衰弱症（CFS 评分为 4：1.99[1.51-2.62]）、患有轻度衰弱症（CFS 评分为 5：2.61[1.99-3.43]）、患有中度衰弱症（CFS 评分为 6：2.97[2.26-3.90]）和患有重度衰弱症（CFS 评分为 7-8：4.03[3.04-5.34]）的患者住院死亡风险增加。
我们的研究结果支持在创伤途径中纳入 CFS 以帮助患者管理。此外，经常锻炼的人（CFS 评分为 1-2）比活动水平较低的人（CFS 评分为≥3）有更好的结果，这支持锻炼作为改善创伤结果的干预措施。
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