吞咽困难与老年创伤患者更差的临床结局相关。
Dysphagia is associated with worse clinical outcomes in geriatric trauma patients.
作者信息
Kregel Heather R, Attia Mina, Pedroza Claudia, Meyer David E, Wandling Michael W, Dodwad Shah-Jahan M, Wade Charles E, Harvin John A, Kao Lillian S, Puzio Thaddeus J
机构信息
Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.
Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.
出版信息
Trauma Surg Acute Care Open. 2022 Dec 5;7(1):e001043. doi: 10.1136/tsaco-2022-001043. eCollection 2022.
INTRODUCTION
Dysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcomes compared with those without dysphagia.
METHODS
Patients with and without dysphagia were compared in a single-center retrospective cohort study of trauma patients aged ≥65 years admitted in 2019. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, discharge destination, and unplanned ICU admission. Multivariable regression analyses and Bayesian analyses adjusted for age, Injury Severity Score, mechanism of injury, and gender were performed to determine the association between dysphagia and clinical outcomes.
RESULTS
Of 1706 geriatric patients, 69 patients (4%) were diagnosed with dysphagia. Patients with dysphagia were older with a higher Injury Severity Score. Increased odds of mortality did not reach statistical significance (OR 1.6, 95% CI 0.6 to 3.4, p=0.30). Dysphagia was associated with increased odds of unplanned ICU admission (OR 4.6, 95% CI 2.0 to 9.6, p≤0.001) and non-home discharge (OR 5.2, 95% CI 2.4 to 13.9, p≤0.001), as well as increased ICU LOS (OR 4.9, 95% CI 3.1 to 8.1, p≤0.001), and hospital LOS (OR 2.1, 95% CI 1.7 to 2.6, p≤0.001). On Bayesian analysis, dysphagia was associated with an increased probability of longer hospital and ICU LOS, unplanned ICU admission, and non-home discharge.
CONCLUSIONS
Clinically apparent dysphagia is associated with poor outcomes, but it remains unclear if dysphagia represents a modifiable risk factor or a marker of underlying frailty, leading to poor outcomes. This study highlights the importance of screening protocols for dysphagia in geriatric trauma patients to possibly mitigate adverse outcomes.
LEVEL OF EVIDENCE
Level III.
引言
吞咽困难与住院患者的发病率、死亡率增加以及资源利用有关，但关于老年创伤性吞咽困难患者预后的研究有限。我们假设，与无吞咽困难的老年创伤患者相比，有吞咽困难的患者临床预后更差。
方法
在一项对2019年收治的年龄≥65岁的创伤患者进行的单中心回顾性队列研究中，对有和无吞咽困难的患者进行了比较。主要结局是死亡率。次要结局包括重症监护病房（ICU）住院时间（LOS）、住院LOS、出院去向和非计划入住ICU。进行了多变量回归分析和贝叶斯分析，并对年龄、损伤严重程度评分、损伤机制和性别进行了校正，以确定吞咽困难与临床结局之间的关联。
结果
在1706例老年患者中，69例（4%）被诊断为吞咽困难。有吞咽困难的患者年龄更大，损伤严重程度评分更高。死亡率增加的几率未达到统计学显著性（比值比1.6，95%置信区间0.6至3.4，p = 0.30）。吞咽困难与非计划入住ICU的几率增加（比值比4.6，95%置信区间2.0至9.6，p≤0.001）、非回家出院（比值比5.2，95%置信区间2.4至13.9，p≤0.001）以及ICU LOS增加（比值比4.9，95%置信区间3.1至8.1，p≤0.001）和住院LOS增加（比值比2.1，95%置信区间1.7至2.6，p≤0.001）相关。在贝叶斯分析中，吞咽困难与住院和ICU LOS延长、非计划入住ICU以及非回家出院的概率增加相关。
结论
临床上明显的吞咽困难与不良结局相关，但尚不清楚吞咽困难是代表一个可改变的危险因素还是潜在虚弱的一个标志，从而导致不良结局。本研究强调了对老年创伤患者进行吞咽困难筛查方案的重要性，以可能减轻不良结局。
证据水平
三级。
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