Centre for Trauma Sciences, Queen Mary University, London, England.
University Hospital Southampton NHS Foundation Trust, Southampton, England.
Scand J Trauma Resusc Emerg Med. 2024 Jan 4;32(1):1. doi: 10.1186/s13049-023-01169-8.
Pre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission.
This was a multi-centre study of patients aged ≥ 65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5 L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5 L VAS at follow up.
Fifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p = 0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p = 0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤ 50) for frail patients (Frail: 65% vs. Not-frail: 30% p < 0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p = 0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p = 0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p = 0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p = 0.01).
Frailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.
在老年创伤患者中，受伤前虚弱与住院期间的不良预后相关，但与长期生存和康复的关系尚不清楚。我们旨在调查老年脆弱患者在接受主要创伤中心（MTC）入院后 6 个月的出院后生存和与健康相关的生活质量（HRQoL）。
这是一项对≥65 岁的 5 个 MTC 入院患者的多中心研究。通过问卷在出院时和 6 个月后收集数据。主要结局是使用 Euroqol EQ5D-5L 视觉模拟量表（VAS）在随访时报告的患者报告的 HRQoL。次要结局包括根据 EQ5D 维度和随访时的护理需求评估的健康状况。采用多变量线性回归分析评估预测变量与随访时 EQ-5D-5L VAS 之间的关系。
在随访期间有 54 例患者死亡，其中三分之二（64%）在受伤前被归类为虚弱，而在 133 例幸存者中只有 21 例（16%）。出院时虚弱和非虚弱患者的自我报告 HRQoL 没有差异（平均 EQ-VAS：虚弱 55.8 vs. 非虚弱 64.1，p=0.137），但非虚弱组的 HRQoL 在随访时有所改善，而虚弱组的 HRQoL则恶化（平均 EQ-VAS：虚弱：50.0 vs. 非虚弱：65.8，p=0.009）。在 6 个月时，虚弱患者的生活质量较差（VAS≤50）增加了两倍（虚弱：65% vs. 非虚弱：30%，p<0.009）。虚弱（β-13.741[95%CI-25.377，2.105]，p=0.02）、年龄增加（β-1.064[95%CI-1.705，-0.423]，p=0.00）和非家庭出院（β-12.017[95%CI118.403，207.203]，p=0.04）与随访时的 HRQoL 较差相关。在随访时，虚弱患者对专业护理的需求增加了五倍（虚弱：25% vs. 非虚弱：4%，p=0.01）。
受伤后虚弱与出院后死亡率增加有关，而老年创伤幸存者的 HRQoL 较差，出院后 6 个月时的护理需求增加。受伤前的虚弱是创伤后长期 HRQoL 不良的预测因素，认识到这一点可以早期启用专科途径和出院计划。
