From the Perioperative Service (M.T.I., C.M., C.E.-B., L.F.), Royal Perth Hospital; and University of Western Australia (M.T.I., M.T., C.E.-B., L.F.), Perth, Australia.
J Trauma Acute Care Surg. 2024 Sep 1;97(3):478-487. doi: 10.1097/TA.0000000000004320.
Trauma is the most common cause of morbidity and mortality in older people, and it is important to determine the predictors of outcomes after major trauma in older people.
MEDLINE, Embase, and Web of Science were searched, and manual search of relevant papers since 1987 to February 2023 was performed. Random-effects meta-analyses were performed. The primary outcome of interest was mortality, and secondary outcomes were medical complications, length of stay, discharge destination, readmission, and intensive care requirement.
Among 6,064 studies in the search strategy, 136 studies qualified the inclusion criteria. Forty-three factors, ranging from demographics to patient factors, admission measurements, and injury factors, were identified as potential predictors. Mortality was the commonest outcome investigated, and increasing age was associated with increased risk of in-hospital mortality (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.07) along with male sex (OR, 1.40; 95% CI, 1.24-1.59). Comorbidities of heart disease (OR, 2.59; 95% CI, 1.41-4.77), renal disease (OR, 2.52; 95% CI, 1.79-3.56), respiratory disease (OR, 1.40; 95% CI, 1.09-1.81), diabetes (OR, 1.35; 95% CI, 1.03-1.77), and neurological disease (OR, 1.42; 95% CI, 0.93-2.18) were also associated with increased in-hospital mortality risk. Each point increase in the Glasgow Coma Scale lowered the risk of in-hospital mortality (OR, 0.85; 95% CI, 0.76-0.95), while each point increase in Injury Severity Score increased the risk of in-hospital mortality (OR, 1.07; 95% CI, 1.04-1.09). There were limited studies and substantial variability in secondary outcome predictors; however, medical comorbidities, frailty, and premorbid living condition appeared predictive for those outcomes.
This review was able to identify potential predictors for older trauma patients. The identification of these factors allows for future development of risk stratification tools for clinicians.
Systematic Review and Meta-Analysis; Level III.
创伤是老年人发病率和死亡率的最常见原因，确定老年人重大创伤后结局的预测因素很重要。
检索 MEDLINE、Embase 和 Web of Science，并对 1987 年至 2023 年 2 月的相关文献进行手工检索。进行了随机效应荟萃分析。主要结局指标是死亡率，次要结局指标是医疗并发症、住院时间、出院去向、再入院和重症监护需求。
在搜索策略中，有 6064 项研究符合纳入标准。确定了 43 个潜在预测因素，范围从人口统计学因素到患者因素、入院测量值和损伤因素。死亡率是最常见的研究结局，年龄增长与院内死亡率增加相关（比值比 [OR]，1.05；95%置信区间 [CI]，1.03-1.07），男性（OR，1.40；95%CI，1.24-1.59）。心脏病（OR，2.59；95%CI，1.41-4.77）、肾病（OR，2.52；95%CI，1.79-3.56）、呼吸疾病（OR，1.40；95%CI，1.09-1.81）、糖尿病（OR，1.35；95%CI，1.03-1.77）和神经疾病（OR，1.42；95%CI，0.93-2.18）等合并症也与院内死亡率增加相关。格拉斯哥昏迷评分每增加 1 分，院内死亡率的风险就降低（OR，0.85；95%CI，0.76-0.95），而损伤严重度评分每增加 1 分，院内死亡率的风险就增加（OR，1.07；95%CI，1.04-1.09）。次要结局预测因素的研究较少，变异性较大；然而，医疗合并症、虚弱和发病前生活状况似乎对这些结局有预测作用。
本综述能够确定老年创伤患者的潜在预测因素。这些因素的识别为临床医生开发风险分层工具提供了可能。
系统评价和荟萃分析；III 级。
