Mechanical Restraint Use and Fall-related Injuries among Residents of Skilled Nursing Facilities
Mechanical Restraint Use and Fall-related Injuries among Residents of Skilled Nursing Facilities
复制标题
熟练护理机构居民的机械约束使用和跌倒相关伤害
DOI：
10.7326/0003-4819-116-5-369
复制
发表时间：
1992
影响因子：
39.2
通讯作者：
S. Ginter
中科院分区：
文献类型：
--
作者：
M. Tinetti;Wen;S. Ginter
目的
评估居住在专业护理机构的人员使用机械约束装置与伤害性福尔斯发生率之间的相关性。
设计
前瞻性观察性队列研究。
设置
康涅狄格州南部的12家专业护理机构。
参与者
基线时移动的和不受限制的397人。
测量
限制使用被定义为限制的天数和"从不"、"间歇性"或"持续"限制。主要结局指标是发生严重跌倒相关损伤。对整个队列以及假设为具有高福尔斯风险的亚组进行分析。
主要结果
在一年的随访中，122名受试者（31%）变得克制，83名间歇性和39名持续性。5%（15/275）的无约束受试者发生了严重的跌倒相关损伤，而17%（21/122）的约束受试者发生了严重的跌倒相关损伤（卡方= 12.478; P <0.001）。在调整其他因素后，在整个队列（调整后比值比，10.2; 95% CI，2.8至36.9）和高危亚组（调整后比值比，6.2; CI，1.7至22.2）中，约束使用仍然与严重损伤独立相关。在发生两次或更少福尔斯跌倒的305例受试者中，受约束受试者发生严重损伤的比例为15%，而不受约束受试者发生严重损伤的比例为4%（比例差异为11%，CI为4%-17%），而发生两次以上福尔斯跌倒的92例受试者发生严重损伤的比例分别为20%和16%。高风险亚组的结果相似。
结论
在控制了其他伤害危险因素后，机械限制与持续的，也许是增加的严重跌倒相关伤害的发生有关。研究结果表明，有必要考虑限制措施是否提供了充分的保护。
OBJECTIVE
To evaluate the association between mechanical restraint use and the occurrence of injurious falls among persons residing in skilled nursing facilities.
DESIGN
Prospective observational cohort study.
SETTING
Twelve skilled nursing facilities in southern Connecticut.
PARTICIPANTS
The 397 persons who were mobile and unrestrained at baseline.
MEASUREMENTS
Restraint use was defined both as the number of days restrained and as "never," "intermittently," or "continually" restrained. The primary outcome measure was the occurrence of a serious fall-related injury. Analyses were done on the entire cohort as well as on a subgroup hypothesized as having a high risk for falls.
MAIN RESULTS
During one year of follow-up, 122 subjects (31%) became restrained, 83 intermittently and 39 continually. A serious fall-related injury was experienced by 5% (15 of 275) of unrestrained, compared with 17% (21 of 122) of restrained, subjects (chi-square = 12.478; P less than 0.001). Restraint use remained independently associated with serious injury after adjusting for other factors, both in the entire cohort (adjusted odds ratio, 10.2; 95% CI, 2.8 to 36.9) and in the high-risk subgroup (adjusted odds ratio, 6.2; CI, 1.7 to 22.2). Among the 305 subjects who experienced two or fewer falls, the proportion having a serious injury was 15% for restrained subjects compared with 4% for unrestrained subjects (difference in proportions 11%, CI, 4% to 17%), whereas the comparable proportions for the 92 subjects who experienced more than two falls were 20% and 16%, respectively. Results were similar in the high-risk subgroup.
CONCLUSIONS
Mechanical restraints were associated with continued, and perhaps increased, occurrence of serious fall-related injuries after controlling for other injury risk factors. Study results suggest the need to consider whether restraints provide adequate, if any, protection.
DOI：
10.1093/geronj/46.5.m164
发表时间：
1991-09-01
期刊：
JOURNALS OF GERONTOLOGY
影响因子：
--
作者：
NEVITT, MC;CUMMINGS, SR;HUDES, ES
通讯作者：
HUDES, ES