Defining geriatric trauma: When does age make a difference?
Defining geriatric trauma: When does age make a difference?
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DOI：
10.1016/j.surg.2012.08.017
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发表时间：
2012-10-01
期刊：
影响因子：
3.8
通讯作者：
Marshall, Gary T.
中科院分区：
文献类型：
--
作者：
Goodmanson, Nicholas W.;Rosengart, Matthew R.;Marshall, Gary T.
背景资料。受伤的老年患者到创伤中心(TCS)的分流不足的比率很高，而关于定义老年创伤患者的年龄的争论仍在继续。我们试图确定受伤患者的死亡风险何时仅因年龄而增加，以确定TC护理是否与这些患者的预后改善相关，并使用年龄阈值来评估TCS增加的入院负担。我们对2001年4月1日至2005年3月31日在宾夕法尼亚州接受TCS和非TCS治疗的受伤患者进行了一项回顾性队列研究。如果患者的年龄在19岁到100岁之间，并且遭受了轻微的损伤(损伤严重程度评分<；9)，则包括在内。主要结果是住院死亡率。我们用分式多项式方法分析年龄对死亡率的预测作用。共有104,015名患者纳入研究。与19岁的患者相比，57岁的患者死亡风险显著增加(优势比5.58；95%可信区间1.07-29.0；P=0.04)。与非TC护理相比，TC护理与死亡风险降低相关(优势比0.83；95%可信区间0.69-0.99；P=0.04)。使用70岁作为强制分诊的阈值，我们估计TCS预计每年大约每天增加一次入院。年龄是创伤患者死亡率的重要危险因素，TC护理即使在年龄较大、损伤最轻的患者中也能改善预后。年龄阈值应被视为TC分诊的标准。使用临床相关的70岁作为这一门槛不会对每年的TC入院人数造成实质性的增加。(Surgery 2012；152：668-75。)
Background. Injured elderly patients experience high rates of undertriage to trauma centers (TCs) whereas debate continues regarding the age defining a geriatric trauma patient. We sought to identify when mortality risk increases in injured patients as the result of age alone to determine whether TC care was associated with improved outcomes for these patients and to estimate the added admissions burden to TCs using an age threshold for triage.Methods. We performed a retrospective cohort study of injured patients treated at TCs and non-TCs in Pennsylvania from April 1, 2001, to March 31, 2005. Patients were included if they were between 19 and 100 years of age and had sustained minimal injury (Injury Severity Score < 9). The primary outcome was in-hospital mortality. We analyzed age as a predictor of mortality by using the fractional polynomial method.Results. A total of 104,015 patients were included. Mortality risk significantly increased at 57 years (odds ratio 5.58; 95% confidence interval 1.07-29.0; P = .04) relative to 19-year-old patients. TC care was associated with a decreased mortality risk compared with non-TC care (odds ratio 0.83; 95% confidence interval 0.69-0.99; P = .04). Using an age of 70 as a threshold for mandatory triage, we estimated TCs could expect an annual increase of approximately one additional admission per day.Conclusion. Age is a significant risk factor for mortality in trauma patients, and TC care improves outcomes even in older, minimally injured patients. An age threshold should be considered as a criterion for TC triage. Use of the clinically relevant age of 70 as this threshold would not impose a substantial increase on annual TC admissions. (Surgery 2012;152:668-75.)