O'Rorke Sarah, Tipping Claire J, Lodge Margot, Mathew Joseph, Kimmel Lara
Physiotherapy Department, Alfred Hospital, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health of Older People, Alfred Health, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; School of Translational Medicine, Monash University, Melbourne, Australia.
Injury. 2025 Feb;56(2):112037. doi: 10.1016/j.injury.2024.112037. Epub 2024 Nov 19.
Recent evidence suggests that frailty may be a more reliable measure than age to predict outcomes following trauma. Frailty leads to prolonged hospitalisation and increased burden on the hospital system in older patients. The aim of this study is to review the prevalence of frailty in our trauma patients and the association of frailty with hospital-based and twelve-month outcomes.
Patient demographics, discharge destination, hospital length of stay (LOS), and functional status at 12 months were reviewed. Frailty was assessed using the Clinical Frailty Scale (score <4 non frail, 4 vulnerable, >4 frail). Factors associated with frailty and outcomes including discharge destination (home or inpatient care) and LOS (p value <0.2) were included in multivariate models.
There were 1230 patients admitted to the trauma ward between November 2020-August 2021 who had linked registry data. Of these, 217 (17.6 %) were deemed frail with 131 (10.7 %) being vulnerable. In the group over 65 years, 38.6 % were frail and 16.1 % were vulnerable. Accounting for confounding factors (including age), being frail was associated with discharge to further inpatient care (AOR 4.82 (3.02 - 7.68), p value <0.001). At 12 months post injury, the mortality rate of patients with frailty was 28 %, compared to 2 % for the rest of the population and patients reported significantly more problems with undertaking daily tasks such as mobility and self-care.
After adjusting for confounding factors, frailty is associated with nearly five times the increase in odds of a discharge to further inpatient care. Long term outcomes are also significantly poorer for patients with frailty. Identifying frailty on admission may help outcomes by targeting this patient group and optimising healthcare resource usage.
最近的证据表明，在预测创伤后的预后方面，衰弱可能是比年龄更可靠的指标。衰弱会导致老年患者住院时间延长，并增加医院系统的负担。本研究的目的是回顾我们创伤患者中衰弱的患病率以及衰弱与基于医院的结局和十二个月结局之间的关联。
回顾了患者的人口统计学资料、出院目的地、住院时间（LOS）以及12个月时的功能状态。使用临床衰弱量表评估衰弱情况（评分<4为非衰弱，4为脆弱，>4为衰弱）。多变量模型纳入了与衰弱和结局相关的因素，包括出院目的地（回家或住院护理）和住院时间（p值<0.2）。
2020年11月至2021年8月期间，有1230名患者入住创伤病房并关联了登记数据。其中，217名（17.6%）被认为衰弱，131名（10.7%）为脆弱。在65岁以上的人群中，38.6%为衰弱，16.1%为脆弱。在考虑混杂因素（包括年龄）后，衰弱与转至进一步住院护理相关（调整后比值比[AOR]为4.82[3.02 - 7.68]，p值<0.001）。受伤后12个月，衰弱患者的死亡率为28%，其余人群为2%，且患者在进行诸如活动和自我护理等日常任务时报告的问题明显更多。
在调整混杂因素后，衰弱与转至进一步住院护理的几率增加近五倍相关。衰弱患者的长期结局也明显更差。入院时识别衰弱可能有助于通过针对该患者群体并优化医疗资源使用来改善结局。
