Ibitoye Sarah E, Braude Philip, Carter Ben, Rickard Frances, Deakin Helen, Martin Rebecca, Thompson Julian, Walton Benjamin, Shipway David
North Bristol NHS Trust and CLARITY (Collaborative Ageing Research) group, Bristol, UK.
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Ann Surg. 2023 Feb 1;277(2):343-349. doi: 10.1097/SLA.0000000000005092. Epub 2023 Jan 10.
To evaluate the effect of geriatrician review on 1-year mortality in older adults admitted with trauma.
Comprehensive geriatric assessment (CGA) has been associated with improved outcomes in older adults with hip fracture, but has not been evaluated in a broader trauma population.
Trauma patients aged ≥ 65years admitted to an English Major Trauma Centre between November 2018 and September 2019 were included. Patients were divided into 3 cohorts: no geriatric assessment, reactive geriatric assessment, and proactive CGA. The primary outcome was time to mortality, secondary outcomes were time to discharge and frequency of complications. Analyses were adjusted for factors known to be associated with outcomes including age, frailty, injury severity, and complications.
Five hundred eighty-five patients were included (no geriatric assessment = 125; reactive geriatric assessment = 134; proactive CGA = 326): median age was 81 years (IQR 74-88); 326 (55.7%) were women; 297 (50.8%) were living with frailty (Clinical Frailty Scale ≥5). Median Injury Severity Score was 13 (IQR9-25). At 1-year follow-up, 147 (25.1%) patients had died. In multivariate analysis, both types of geriatric assessment were associated with reduced mortality [reactive aHR = 0.31, 95% CI 0.18-0.53; proactive adjusted hazard ratio (aHR) = 0.41, 95% CI 0.26-0.64]. There was no association between either type of geriatric assessment and length of stay (reactive aHR = 0.84, 95% CI 0.62-1.15; proactive aHR = 0.80, 95% CI 0.63-1.02).
Geriatrician assessment is associated with reduced mortality in older adults admitted following trauma. Further research should focus on defining optimal models of geriatrician intervention.
评估老年医学专家评估对因创伤入院的老年人1年死亡率的影响。
综合老年评估（CGA）与老年髋部骨折患者预后改善相关，但尚未在更广泛的创伤人群中进行评估。
纳入2018年11月至2019年9月间入住英国一家主要创伤中心的65岁及以上创伤患者。患者分为3组：未进行老年评估组、反应性老年评估组和主动性CGA组。主要结局是死亡时间，次要结局是出院时间和并发症发生频率。分析针对已知与结局相关的因素进行了调整，包括年龄、虚弱程度、损伤严重程度和并发症。
共纳入585例患者（未进行老年评估组=125例；反应性老年评估组=134例；主动性CGA组=326例）：中位年龄为81岁（四分位间距74 - 88岁）；326例（55.7%）为女性；297例（50.8%）存在虚弱（临床虚弱量表≥5）。中位损伤严重程度评分为13分（四分位间距9 - 25分）。在1年随访时，147例（25.1%）患者死亡。在多变量分析中，两种类型的老年评估均与死亡率降低相关[反应性校正风险比（aHR）=0.31，95%置信区间（CI）0.18 - 0.53；主动性校正风险比（aHR）=0.41，95%CI 0.26 - 0.64]。两种类型的老年评估与住院时间均无关联（反应性aHR =0.84，95%CI 0.62 - 1.15；主动性aHR =0.80，95%CI 0.63 - 1.02）。
老年医学专家评估与创伤后入院的老年人死亡率降低相关。进一步研究应聚焦于确定老年医学专家干预的最佳模式。
