Head Trauma from Falling Increases Subsequent Emergency Department Visits More Than Other Fall-Related Injuries in Older Adults.
Head Trauma from Falling Increases Subsequent Emergency Department Visits More Than Other Fall-Related Injuries in Older Adults.
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DOI：
10.1111/jgs.14041
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发表时间：
2016-04
影响因子：
6.3
通讯作者：
Caterino JM
中科院分区：
文献类型：
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作者：
Southerland LT;Stephens JA;Robinson S;Falk J;Phieffer L;Rosenthal JA;Caterino JM
跌倒的老年人在首次就诊后返回急诊科（ED）的风险很高。我们调查了与跌倒有关的伤害是否会影响ED的再犯。这是一项对≥65岁患者的回顾性图表回顾，这些患者在学术一级创伤中心急诊评估从站立高度或更低的高度坠落并出院。经机构审查委员会批准后，查询电子病历数据。使用单变量和多变量逻辑回归模型来确定与90天内重返ED风险增加相关的因素。在18个月的研究期间，263名65岁及以上的成年人在急诊科进行了跌倒评估并出院。平均年龄77岁，女性占70%。损伤包括骨折（45%,n=117）、头部外伤（22%,n=58）、擦伤、撕裂或挫伤（34%,n=88）或无损伤（22%,n=57）。患者经常需要急诊治疗，其中5% (n=13)[95% CI, 2.3-7.6%]在72小时内返回，13% (n= 35)[95% CI， 9.2-17%]在30天内返回，22% (n=57)[95% CI， 17-27%]在90天内返回。单因素来看，有头部外伤的患者在90天内返回急诊室的几率是没有头部外伤的患者的两倍多（优势比（OR） 2.66）。这在控制Charlson合并症指数、骨折、软组织损伤和ED观察单元使用的多变量模型中仍然是显著的。超过三分之一的老年人因跌倒造成轻微头部创伤，需要在接下来的90天内回到急诊室。这些患者应得到初级保健提供者的密切关注。轻度头部创伤与ED再犯之间的联系是一项新发现。
Older adults with falls are at high risk for returning to the Emergency Department (ED) after their initial visit for a fall. We investigated whether fall-related injuries affected ED recidivism. This was a retrospective chart review of patients ≥65 years old evaluated in an academic Level 1 trauma center ED for a fall from standing height or less and discharged. After Institutional Review Board approval, electronic medical record data was queried. Univariate and multivariable logistic regression models were used to determine factors associated with increased risk of returning to the ED over 90 days. Two hundred sixty three adults aged 65 and older were evaluated in the ED for a fall and discharged during the 18 month study period. Average age was 77 years and 70% were female. Injuries suffered include fractures (45%, n=117), head trauma (22%, n=58), abrasions, lacerations, or contusions (34%, n=88), or none (22%, n=57). Patients required emergency care frequently, with 5% (n=13)[95% CI, 2.3-7.6%] returning within 72 hours, 13% (n= 35)[95% CI, 9.2-17%] returning within 30 days and 22% (n=57)[95% CI, 17-27%] within 90 days. Univariately, the odds of returning to the ED within 90 days was over two times higher for those with head trauma compared to those without (odds ratio (OR) 2.66). This remained significant in the multivariable model, which controlled for Charlson Comorbidity Index, fractures, soft tissue injuries, and ED observation unit use. Over a third of older adults with minor head trauma from a fall will need to return to the ED in the following 90 days. These patients should receive close attention from primary care providers. The link between minor head trauma and ED recidivism is a new finding.