创伤性损伤老年患者伤前衰弱状况及临床护理轨迹：对美国一家大型一级创伤中心的回顾性队列分析
Pre-injury frailty and clinical care trajectory of older adults with trauma injuries: A retrospective cohort analysis of A large level I US trauma center.
作者信息
Adeyemi Oluwaseun, Grudzen Corita, DiMaggio Charles, Wittman Ian, Velez-Rosborough Ana, Arcila-Mesa Mauricio, Cuthel Allison, Poracky Helen, Meyman Polina, Chodosh Joshua
机构信息
Ronald O Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, United States of America.
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
出版信息
PLoS One. 2025 Feb 5;20(2):e0317305. doi: 10.1371/journal.pone.0317305. eCollection 2025.
BACKGROUND
Pre-injury frailty among older adults with trauma injuries is a predictor of increased morbidity and mortality.
OBJECTIVES
We sought to determine the relationship between frailty status and the care trajectories of older adult patients who underwent frailty screening in the emergency department (ED).
METHODS
Using a retrospective cohort design, we pooled trauma data from a single institutional trauma database from August 2020 to June 2023. We limited the data to adults 65 years and older, who had trauma injuries and frailty screening at ED presentation (N = 2,862). The predictor variable was frailty status, measured as either robust (score 0), pre-frail (score 1-2), or frail (score 3-5) using the FRAIL index. The outcome variables were measures of clinical care trajectory: trauma team activation, inpatient admission, ED discharge, length of hospital stay, in-hospital death, home discharge, and discharge to rehabilitation. We controlled for age, sex, race/ethnicity, health insurance type, body mass index, Charlson Comorbidity Index, injury type and severity, and Glasgow Coma Scale score. We performed multivariable logistic and quantile regressions to measure the influence of frailty on post-trauma care trajectories.
RESULTS
The mean (SD) age of the study population was 80 (8.9) years, and the population was predominantly female (64%) and non-Hispanic White (60%). Compared to those classified as robust, those categorized as frail had 2.5 (95% CI: 1.86-3.23), 3.1 (95% CI: 2.28-4.12), and 0.3 (95% CI: 0.23-0.42) times the adjusted odds of trauma team activation, inpatient admission, and ED discharge, respectively. Also, those classified as frail had significantly longer lengths of hospital stay as well as 3.7 (1.07-12.62), 0.4 (0.28-0.47), and 2.2 (95% CI: 1.71-2.91) times the odds of in-hospital death, home discharge, and discharge to rehabilitation, respectively.
CONCLUSION
Pre-injury frailty is a predictor of clinical care trajectories for older adults with trauma injuries.
背景
创伤性损伤的老年患者伤前虚弱是发病率和死亡率增加的一个预测因素。
目的
我们试图确定虚弱状态与在急诊科（ED）接受虚弱筛查的老年患者的护理轨迹之间的关系。
方法
采用回顾性队列设计，我们汇总了2020年8月至2023年6月来自单一机构创伤数据库的创伤数据。我们将数据限制在65岁及以上、在ED就诊时遭受创伤性损伤并接受虚弱筛查的成年人（N = 2862）。预测变量是虚弱状态，使用FRAIL指数测量，分为强健（得分0）、衰弱前期（得分1 - 2）或虚弱（得分3 - 5）。结局变量是临床护理轨迹的指标：创伤团队启动、住院、ED出院、住院时间、院内死亡、回家出院以及出院至康复机构。我们控制了年龄、性别、种族/民族、健康保险类型、体重指数、Charlson合并症指数、损伤类型和严重程度以及格拉斯哥昏迷量表评分。我们进行了多变量逻辑回归和分位数回归，以测量虚弱对创伤后护理轨迹的影响。
结果
研究人群的平均（标准差）年龄为80（8.9）岁，人群主要为女性（64%）和非西班牙裔白人（60%）。与被归类为强健的人相比，被归类为虚弱的人创伤团队启动、住院和ED出院的调整后 odds 分别为2.5（95% CI：1.86 - 3.23）、3.1（95% CI：2.28 - 4.12）和0.3（95% CI：0.23 - 0.42）倍。此外，被归类为虚弱的人住院时间明显更长，院内死亡、回家出院以及出院至康复机构的 odds 分别为3.7（1.07 - 12.62）、0.4（0.28 - 0.47）和2.2（95% CI：1.71 - 2.91）倍。
结论
伤前虚弱是创伤性损伤老年患者临床护理轨迹的一个预测因素。
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