Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
Surgery. 2024 Oct;176(4):1148-1154. doi: 10.1016/j.surg.2024.06.036. Epub 2024 Aug 5.
The incidence of severe injury in the geriatric population is increasing. However, the impact of frailty on long-term outcomes after injury in this population remains understudied. Therefore, we aimed to understand the impact of frailty on long-term functional outcomes of severely injured geriatric patients.
We conducted a retrospective cohort study, including patients ≥65 years old with an Injury Severity Score ≥15, who were admitted between December 2015 and April 2022 at one of 3 level 1 trauma centers in our region. Patients were contacted between 6 and 12 months postinjury and administered a trauma quality of life survey, which assessed for the presence of new functional limitations in their activities of daily living. We defined frailty using the mFI-5 validated frailty tool: patients with a score ≥2 out of 5 were considered frail. The impact of frailty on long-term functional outcomes was assessed using 1:1 propensity matching adjusting for patient characteristics, injury characteristics, and hospital site.
We included 580 patients, of whom 146 (25.2%) were frail. In a propensity-matched sample of 125 pairs, frail patients reported significantly higher functional limitations than nonfrail patients (69.6% vs 47.2%; P < .001). This difference was most prominent in the following activities: climbing stairs, walking on flat surfaces, going to the bathroom, bathing, and cooking meals. In a subgroup analysis, frail patients with traumatic brain injuries experienced significantly higher long-term functional limitations.
Frail geriatric patients with severe injury are more likely to have new long-term functional outcomes and may benefit from screening and postdischarge monitoring and rehabilitation services.
老年人群中严重损伤的发生率正在增加。然而，在该人群中，虚弱对损伤后长期结局的影响仍研究不足。因此，我们旨在了解虚弱对严重老年损伤患者长期功能结局的影响。
我们进行了一项回顾性队列研究，纳入了 2015 年 12 月至 2022 年 4 月期间在我们地区的 3 家 1 级创伤中心之一入院、损伤严重程度评分（Injury Severity Score，ISS）≥15 的年龄≥65 岁的患者。患者在损伤后 6 至 12 个月内接受创伤生活质量调查（Trauma Quality of Life survey），评估其日常生活活动中是否出现新的功能限制。我们使用经过验证的 mFI-5 虚弱工具定义虚弱：得分≥2 分的患者被认为虚弱。通过 1:1 倾向评分匹配，根据患者特征、损伤特征和医院地点调整，评估虚弱对长期功能结局的影响。
我们纳入了 580 名患者，其中 146 名（25.2%）患者虚弱。在 125 对匹配的样本中，虚弱患者报告的功能限制明显高于非虚弱患者（69.6%比 47.2%；P<.001）。这种差异在以下活动中最为明显：爬楼梯、在平地上行走、上厕所、洗澡和做饭。在亚组分析中，患有创伤性脑损伤的虚弱老年患者经历了更高的长期功能限制。
患有严重损伤的虚弱老年患者更有可能出现新的长期功能结局，可能受益于筛查以及出院后监测和康复服务。
