Lin Pei-Ying, Huang Hsien-Hao, Yen David Hung-Tsang
Taipei Veterans General Hospital Department of Emergency Medicine Taipei Taiwan.
College of Medicine Emergency Medicine National Yang Ming Chiao Tung University, Taipei Taiwan.
J Acute Med. 2022 Sep 1;12(3):113-121. doi: 10.6705/j.jacme.202209_12(3).0004.
Hip fracture (HF) is a major challenge for healthcare systems in terms of increased costs and lengths of stay, and it has been estimated that by 2050, half of the projected 6.26 million global HFs will occur in Asia. Owing to the high morbidity and mortality associated with HF in elderly individuals, it is crucial to recognize at-risk elderly patients in the ED so that special precautions and preventive measures can be taken. While comprehensive geriatric assessment (CGA) has been shown to improve outcomes and prevent secondary fractures in elderly individuals with HF in outpatient settings, there is a lack of data to identify elderly Asian patients who are at risk of HF via using CGA in the emergency department (ED). The aim of this study is to identify the characteristics of elderly Asian patients in the ED who have an increased risk of HF via CGA.
A case-control study was conducted in the ED at Taipei Veterans General Hospital, a medical center located in Taipei, Taiwan, from October 2018 to December 2019. Patients > 75 years old with and without HF were compared using data obtained from CGAs conducted by trained nurses.
A total of 85 HF patients (cases) and 680 non-HF patients were enrolled, among whom 340 non-HF control individuals (controls) were selected by simple random sampling. HF occurred more frequently in women and in patients with depressive symptoms. An association between decreased handgrip strength and HF risk, especially in men, was also identified ( = 0.011). The variables independently associated with the presence of HF in the multivariate analysis were female sex (odds ratio [OR]: 2.229; 95% confidence interval [CI]: 1.332-3.728) and decreased handgrip strength (OR: 2.462; 95% CI: 1.155-5.247).
By performing CGAs in the ED, we found that female sex and decreased handgrip strength were associated with HF risk. Therefore, we propose that targeted assessment of handgrip strength in female patients aged > 75 years in the ED may identify those at greatest risk of HF, resulting in improved emergency care for geriatric patients.
髋部骨折（HF）在成本增加和住院时间延长方面对医疗保健系统构成重大挑战，据估计，到2050年，预计全球626万例髋部骨折中有一半将发生在亚洲。由于老年个体髋部骨折相关的高发病率和死亡率，在急诊科识别高危老年患者至关重要，以便采取特殊预防措施和预防措施。虽然综合老年评估（CGA）已被证明可改善门诊环境中患有髋部骨折的老年个体的预后并预防二次骨折，但缺乏数据来通过在急诊科（ED）使用CGA识别有髋部骨折风险的亚洲老年患者。本研究的目的是通过CGA识别急诊科有髋部骨折风险增加的亚洲老年患者的特征。
2018年10月至2019年12月在台湾台北的一家医疗中心台北荣民总医院急诊科进行了一项病例对照研究。使用经过培训的护士进行的CGA获得的数据，对年龄>75岁有和没有髋部骨折的患者进行比较。
共纳入85例髋部骨折患者（病例）和680例非髋部骨折患者，其中通过简单随机抽样选择340例非髋部骨折对照个体（对照）。髋部骨折在女性和有抑郁症状的患者中更频繁发生。还确定了握力下降与髋部骨折风险之间的关联，尤其是在男性中（P = 0.011）。多变量分析中与髋部骨折存在独立相关的变量是女性（优势比[OR]：2.229；95%置信区间[CI]：1.332 - 3.728）和握力下降（OR：2.462；95%CI：1.155 - 5.247）。
通过在急诊科进行CGA，我们发现女性和握力下降与髋部骨折风险相关。因此，我们建议在急诊科对年龄>75岁的女性患者进行握力的针对性评估，可能识别出髋部骨折风险最高的患者，从而改善老年患者的急诊护理。
