一项针对 23 个主要创伤中心的全国性研究，旨在调查在英格兰因严重受伤而入院的老年人中，老年病医生评估对临床结局的影响（FiTR 2）：一项多中心观察性队列研究。
A national study of 23 major trauma centres to investigate the effect of a geriatrician assessment on clinical outcomes in older people admitted with serious injury in England (FiTR 2): a multicentre observational cohort study.
机构信息
CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, 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.
出版信息
Lancet Healthy Longev. 2022 Aug;3(8):e549-e557. doi: 10.1016/S2666-7568(22)00144-1. Epub 2022 Jul 4.
BACKGROUND
Older people are at the greatest risk of poor outcomes after serious injury. Evidence is limited for the benefit of assessment by a geriatrician in trauma care. We aimed to determine the effect of geriatrician assessment on clinical outcomes for older people admitted to hospital with serious injury.
METHODS
In this multicentre observational study (FiTR 2), we extracted prospectively collected data on older people (aged ≥65 years) admitted to the 23 major trauma centres in England over a 2·5 year period from the Trauma Audit and Research Network (TARN) database. We examined the effect of a geriatrician assessment within 72 h of admission on the primary outcome of inpatient mortality in older people admitted to hospital with serious injury, with patients censored at discharge. We analysed data using a multi-level Cox regression model and estimated adjusted hazard ratios (aHRs).
FINDINGS
Between March 31, 2019, and Oct 31, 2021, 193 156 patients had records held by TARN, of whom 35 490 were included in these analyses. Median age was 81·4 years (IQR 74·1-87·6), 19 468 (54·9%) were female, and 16 022 (45·1%) were male. 28 208 (79·5%) patients had experienced a fall from less than 2 m. 16 504 (46·5%) people received a geriatrician assessment. 4419 (12·5%) patients died during hospital stay, with a median time from admission to death of 6 days (IQR 2-14). Of those who died, 1660 (37·6%) had received a geriatrician assessment and 2759 (62·4%) had not (aHR 0·43 [95% CI 0·40-0·46]; p<0·0001).
INTERPRETATION
Geriatrician assessment was associated with a reduced risk of death for seriously injured older people. These data support routine provision of geriatrician assessment in trauma care. Future research should explore the key components of a geriatrician assessment paired with a health economic evaluation.
FUNDING
None.
背景
老年人在严重受伤后出现不良结局的风险最大。在创伤护理中，老年病医生评估的益处证据有限。我们旨在确定老年病医生评估对因严重受伤而住院的老年人的临床结局的影响。
方法
在这项多中心观察性研究（FiTR 2）中，我们从创伤审核和研究网络（TARN）数据库中提取了在 2.5 年期间英格兰 23 家主要创伤中心收治的年龄≥65 岁的老年人的前瞻性收集数据。我们检查了在入院后 72 小时内进行老年病医生评估对因严重受伤而住院的老年人的主要住院死亡率的影响，患者在出院时被剔除。我们使用多级 Cox 回归模型分析数据，并估计了调整后的危险比（aHR）。
结果
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 35490 名患者纳入了这些分析。中位年龄为 81.4 岁（IQR 74.1-87.6），19468 名（54.9%）为女性，16022 名（45.1%）为男性。28208 名（79.5%）患者从不到 2 m 的高度坠落受伤。16504 名（46.5%）患者接受了老年病医生评估。4419 名（12.5%）患者在住院期间死亡，从入院到死亡的中位时间为 6 天（IQR 2-14）。在死亡患者中，1660 名（37.6%）接受了老年病医生评估，而 2759 名（62.4%）未接受评估（aHR 0.43 [95%CI 0.40-0.46]；p<0.0001）。
解释
老年病医生评估与严重受伤的老年人死亡风险降低相关。这些数据支持在创伤护理中常规提供老年病医生评估。未来的研究应该探讨老年病医生评估与健康经济评估相结合的关键组成部分。
资金
无。
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