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衰弱指数和老年创伤结局评分与老年创伤患者死亡率的关系。

Relationships of the frailty index and geriatric trauma outcome score with mortality in geriatric trauma patients.

机构信息

Department of Emergency Medicine, Haseki Training and Research Hospital, İstanbul-Türkiye.

Department of Emergency Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul-Türkiye.

出版信息

Ulus Travma Acil Cerrahi Derg. 2023 Apr;29(4):486-492. doi: 10.14744/tjtes.2022.85522.

Abstract

BACKGROUND

We aimed to determine the relationships of the trauma-specific frailty index (TSFI) and the geriatric trauma out-come score (GTOS) with 30-day mortality among geriatric trauma patients aged 65 and older.

METHODS

This prospective observational study included 382 patients aged 65 years and older who were admitted to a training and research hospital due to blunt trauma. Informed consent was obtained from them and/or their relatives. In addition to patients' vital signs, information about chronic diseases and drug use was obtained on admission to the emergency service and the results of labo-ratory examinations, radiological imaging, blood replacements, length of stay in the emergency room and hospital, and mortality were recorded in case forms. Glasgow coma scale, ınjury severity score, GTOS, TSFI, and body mass index (BMI) values were calculated by the researchers. Outcome information was obtained from the patient and/or relatives by phone 30 days later.

RESULTS

When the patients who died and those who survived were compared at the 30th day after trauma, no significant difference was found in terms of BMI or TSFI (p>0.05). It was determined that patients with a GTOS of ≥95 at admission would have higher 30-day mortality (the sensitivity was 76%, and the specificity was 72.27% (p<0.001)). When correlations were evaluated according to mortality, a correlation was found between the presence of two or more comorbid diseases and mortality (p=0.001).

CONCLUSION

We think that a more reliable frailty score can be obtained using these parameters as we have determined that the TSFI as calculated at admission to the emergency department is not sufficient on its own, while the lactate, GTOS, and the length of hospital stay are also effective in mortality. We suggest that it would be appropriate to use the GTOS in long-term follow-up as well as for predictive power for mortality within 24 h.

摘要

背景

我们旨在确定创伤特异性脆弱指数(TSFI)和老年创伤结局评分(GTOS)与 65 岁及以上老年创伤患者 30 天死亡率之间的关系。

方法

这项前瞻性观察性研究纳入了 382 名因钝器伤而入住一家培训和研究医院的 65 岁及以上患者。他们或其亲属获得了知情同意。除了患者的生命体征外,还在急诊入院时获取了有关慢性疾病和药物使用的信息,并记录了实验室检查、影像学检查、血液置换、急诊室和医院的住院时间以及死亡率。格拉斯哥昏迷量表、损伤严重程度评分、GTOS、TSFI 和体重指数(BMI)值由研究人员计算。30 天后通过电话向患者和/或亲属获取结局信息。

结果

在创伤后第 30 天比较死亡患者和存活患者时,BMI 或 TSFI 无显著差异(p>0.05)。入院时 GTOS≥95 的患者 30 天死亡率更高(敏感度为 76%,特异度为 72.27%(p<0.001))。根据死亡率评估相关性时,发现存在两种或两种以上合并症与死亡率之间存在相关性(p=0.001)。

结论

我们认为,通过这些参数可以获得更可靠的脆弱性评分,因为我们已经确定,入院时计算的 TSFI 本身并不充分,而乳酸、GTOS 和住院时间也对死亡率有影响。我们建议,在长期随访中使用 GTOS 以及在 24 小时内预测死亡率都很合适。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b72a/10214887/07823cf8a2ba/TJTES-29-486-g001.jpg

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