Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia.
School of Medicine, University of Nottingham, Nottingham, UK.
Age Ageing. 2023 May 1;52(5). doi: 10.1093/ageing/afad073.
The incidence of major trauma in older people is increasing. Frailty is likely to be a factor that influences the outcomes of trauma. We conducted a systematic review aiming to investigate whether frailty affects major trauma outcomes in older people and whether it is more predictive than age.
Observational studies investigating frailty, major trauma severity and outcomes were eligible. We searched electronic databases (Ovid MEDLINE, PubMed, Ovid EMBASE and CINAHL) from 2010 to 01 January 2023. We used Joanna Briggs Institute software to assess the risk of bias and conduct meta-analyses of the relationships between frailty status and outcomes. We used a narrative synthesis to compare the predictive value of frailty and age.
Twelve studies were eligible for meta-analyses. In-hospital mortality (odds ratio (OR) = 1.12, 95% confidence interval (CI) 1.05, 1.19), length of stay (OR = 2.04, 95% CI 1.51, 2.56), discharge to home (OR = 0.58, 95% CI 0.53, 0.63) and in-hospital complications (OR = 1.17, 95% CI 1.10, 1.24) were all associated with frailty. Frailty was found to be a more consistent predictor of adverse outcomes and mortality in older trauma patients than injury severity and age in six studies that reported multivariate regression analysis.
Older trauma patients with frailty have higher in-hospital mortality rates, prolonged hospital stays, in-hospital complications and adverse discharge disposition. Frailty is a better predictor of adverse outcomes than age in these patients. Frailty status is likely to be a useful prognostic variable in guiding patient management and stratifying clinical benchmarks and research trials.
老年人中重大创伤的发生率正在增加。衰弱很可能是影响创伤结局的一个因素。我们进行了一项系统评价，旨在调查衰弱是否影响老年人重大创伤的结局，以及它是否比年龄更具预测性。
符合纳入标准的观察性研究调查了衰弱、严重创伤的严重程度和结局。我们从 2010 年到 2023 年 1 月 1 日检索了电子数据库（Ovid MEDLINE、PubMed、Ovid EMBASE 和 CINAHL）。我们使用 Joanna Briggs Institute 软件评估偏倚风险，并对衰弱状况与结局之间的关系进行荟萃分析。我们使用叙述性综合方法比较了衰弱和年龄的预测价值。
12 项研究适合进行荟萃分析。院内死亡率（比值比（OR）=1.12，95%置信区间（CI）1.05，1.19）、住院时间（OR=2.04，95% CI 1.51，2.56）、出院回家（OR=0.58，95% CI 0.53，0.63）和院内并发症（OR=1.17，95% CI 1.10，1.24）均与衰弱有关。在 6 项报告多元回归分析的研究中，发现衰弱是老年人创伤患者不良结局和死亡率的更一致预测因素，优于损伤严重程度和年龄。
衰弱的老年创伤患者院内死亡率较高，住院时间延长，院内并发症和不良出院处置。在这些患者中，衰弱是不良结局的更好预测指标。衰弱状况可能是指导患者管理和分层临床基准和研究试验的有用预后变量。
