Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial
Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial
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DOI：
10.1016/s0140-6736(14)62409-0
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发表时间：
2015-04-25
期刊：
影响因子：
168.9
通讯作者：
Saltvedt, Ingvild
中科院分区：
文献类型：
--
作者：
Prestmo, Anders;Hagen, Gunhild;Saltvedt, Ingvild
背景大多数髋部骨折患者的特征是年龄较大（> 70岁）、虚弱和功能恶化，其长期结局较差，费用增加。我们比较的有效性和costeffectiveness给这些患者全面的老年护理在一个专门的老年病房与通常的orthogonal care.Methods我们做了一个前瞻性的，单中心的，随机的，平行组，对照试验。在2008年4月18日至2010年12月30日期间，我们将70岁或70岁以上的髋部骨折患者随机分配到急诊科进行综合老年护理或骨科护理，以达到所需的400例患者样本。通过基于网络的计算机生成的区组方法（区组大小未知）实现随机化。按意向治疗分析的主要结局是骨折手术后4个月用短体力活动成套测验（SPPB）测量的活动度。治疗的类型并没有对患者或提供护理的工作人员隐瞒，评估人员在随访期间对治疗仅部分隐瞒。该试验在www.example.com注册，编号NCT 00667914。结果我们评估了1077例患者的资格，排除了680例，主要是因为不符合纳入标准，如住在疗养院或年龄小于70岁。在其余患者中，我们随机分配198人接受综合老年护理，199人接受骨科护理。4个月时，174名患者留在综合老年护理组，170名留在骨科护理组;退出的主要原因是死亡。4个月时的平均SPPB评分为5.12（SE 0.20）用于老年综合护理，4.38（SE 0.20）用于骨科护理（组间差异0.74，95% CI 0.18 - 1.30，p = 0.010）的平均值70岁或以上髋部骨折患者立即入住专门病房接受综合老年护理，月，与常规骨科护理相比。结果表明，老年髋部骨折患者的治疗应组织为正老年护理。
Background Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and costeffectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care.Methods We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914.Findings We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5.12 (SE 0.20) for comprehensive geriatric care and 4.38 (SE 0.20) for orthopaedic care (between-group difference 0.74, 95% CI 0.18-1.30, p= 0.010).Interpretation Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated ward improved mobility at 4 months, compared with the usual orthopaedic care. The results suggest that the treatment of older patients with hip fractures should be organised as orthogeriatric care.