Recurrent Falls Among Elderly Patients and the Impact of Anticoagulation Therapy
Recurrent Falls Among Elderly Patients and the Impact of Anticoagulation Therapy
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DOI：
10.1007/s00268-018-4728-1
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发表时间：
2018-12-01
影响因子：
2.6
通讯作者：
Pei, Kevin Y.
中科院分区：
文献类型：
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作者：
Chiu, Alexander S.;Jean, Raymond A.;Pei, Kevin Y.
背景跌倒是美国老年人受伤和创伤相关住院的主要原因。有跌倒史的老年患者再次跌倒的风险最高，跌倒后很难决定是否继续抗凝治疗。为了告知这一决定，我们评估了复发率福尔斯和抗凝治疗对outcome.MethodsAll患者的年龄65岁，并在2013年和2014年的前6个月住院下降确定在全国范围内的再入院数据库，一个全国代表性的所有付款人数据库跟踪患者再入院。6个月内复发性跌倒再入院，再入院期间死亡率和出血性损伤（颅内出血，实体器官出血和血胸）被确定。Logistic回归分析评估了与重复福尔斯死亡率相关的因素。结果在331,982例因跌倒入院的患者中，15,565例（4.7%）在6个月内因复发性跌倒入院。再次跌倒的中位时间为57天（IQR 19-111天），9.0%（1406）的再次跌倒者接受抗凝治疗。无论抗凝状态如何，出血性损伤的发生率相似（12.8%对12.7%未抗凝，p=0.97）;然而，在出血性损伤患者中，抗凝治疗的患者死亡率显著更高（21.5%对6.9%未抗凝，p
BackgroundFalls are the leading source of injury and trauma-related hospital admissions for elderly adults in the USA. Elderly patients with a history of a fall have the highest risk of falling again, and the decision on whether to continue anticoagulation after a fall is difficult. To inform this decision, we evaluated the rate of recurrent falls and the impact of anticoagulation on outcomes.MethodsAll patients of age 65 years and hospitalized for a fall in the first 6 months of 2013 and 2014 were identified in the nationwide readmission database, a nationally representative all-payer database tracking patient readmissions. Readmissions for a recurrent fall within 6 months, and mortality and bleeding injuries (intracranial hemorrhage, solid organ bleed, and hemothorax) during readmission were identified. Logistic regression evaluated factors associated with mortality on repeat falls.ResultsOf the 331,982 patients admitted for a fall, 15,565 (4.7%) were admitted for a recurrent fall within 6 months. The median time to repeat fall was 57 days (IQR 19-111 days), and 9.0% (1406) of repeat fallers were on anticoagulation. The rate of bleeding injury was similar regardless of anticoagulation status (12.8 vs. 12.7% not on anticoagulation, p=0.97); however, among patients with a bleeding injury, those on anticoagulation had significantly higher mortality (21.5 vs. 6.9% not on anticoagulation, p