Validating Trauma-Specific Frailty Index for Geriatric Trauma Patients: A Prospective Analysis
Validating Trauma-Specific Frailty Index for Geriatric Trauma Patients: A Prospective Analysis
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DOI：
10.1016/j.jamcollsurg.2014.03.020
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发表时间：
2014-07-01
影响因子：
5.2
通讯作者：
Rhee, Peter
中科院分区：
文献类型：
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作者：
Joseph, Bellal;Pandit, Viraj;Rhee, Peter
背景：虚弱指数已被证明可以预测老年患者的出院倾向。本研究的目的是验证修改后的15变量创伤特异性虚弱指数（TSFI），以预测老年创伤患者的出院处置。我们假设TSFI可以预测老年创伤patients.Study DESIGN出院处置：我们进行了为期2年（2011-2013年）的前瞻性分析，所有老年创伤患者提出我们的一级创伤中心。患者出院处置分为不利（出院至专业护理机构或死亡）和有利（出院至家庭或康复中心）出院处置。使用开发的15变量TSFI对患者进行评估。多因素Logistic回归分析，以确定预测不利的出院disposition.Results：共200例患者参加了验证TSFI的因素。平均年龄为77 ± 12.1岁，中位损伤严重度评分为15（四分位数间距[IQR] 9 - 20），中位格拉斯哥昏迷量表评分为14（IQR 13 - 15），中位虚弱指数评分为0.20（IQR 0.17 - 0.28）; 29.5%（n = 59）的患者出院情况不佳。在调整了年龄、性别、损伤严重程度评分、头部简明损伤量表和入院时的生命体征后，虚弱指数（比值比= 1.5; 95%CI，1.1-2.5）是出院后不良处置的唯一显著预测因素。年龄（比值比= 1.2; 95%CI，0.9-3.1; p = 0.2）并不能预测不良出院处置。结论：15个变量TSFI是老年创伤患者不良出院处置的独立预测因素。创伤特异性虚弱指数是一种有效的工具，可以帮助临床医生规划老年创伤患者的出院处置。(C)2014年美国外科医生学会
BACKGROUND: The Frailty Index has been shown to predict discharge disposition in geriatric patients. The aim of this study was to validate the modified 15-variable Trauma-Specific Frailty Index (TSFI) to predict discharge disposition in geriatric trauma patients. We hypothesized that TSFI can predict discharge disposition in geriatric trauma patients.STUDY DESIGN: We performed a 2-year (2011-2013) prospective analysis of all geriatric trauma patients presenting to our Level I trauma center. Patient discharge disposition was dichotomized into unfavorable (discharge to skilled nursing facility or death) and favorable (discharge to home or rehabilitation center) discharge disposition. Patients were evaluated using the developed 15-variable TSFI. Multivariate logistic regression was performed to identify factors that predict unfavorable discharge disposition.RESULTS: A total of 200 patients were enrolled for validation of TSFI. Mean age was 77 +/- 12.1 years, median Injury Severity Score was 15 (interquartile range [IQR] 9 to 20), median Glasgow Coma Scale score was 14 (IQR 13 to 15), and median Frailty Index score was 0.20 (IQR 0.17 to 0.28); 29.5% (n = 59) patients had unfavorable discharge. After adjusting for age, sex, Injury Severity Score, Head Abbreviated Injury Scale, and vitals on admission, Frailty Index (odds ratio = 1.5; 95% CI, 1.1-2.5) was the only significant predictor for unfavorable discharge disposition. Age (odds ratio = 1.2; 95% CI, 0.9-3.1; p = 0.2) was not predictive of unfavorable discharge disposition.CONCLUSIONS: The 15-variable TSFI is an independent predictor of unfavorable discharge disposition in geriatric trauma patients. The Trauma-Specific Frailty Index is an effective tool that can aid clinicians in planning discharge disposition of geriatric trauma patients. (C) 2014 by the American College of Surgeons