A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries
A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries
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DOI：
10.1056/nejmoa2002183
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发表时间：
2020-07-09
影响因子：
158.5
通讯作者：
Peduzzi, Peter
中科院分区：
文献类型：
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作者：
Bhasin, Shalender;Gill, Thomas M.;Peduzzi, Peter
背景跌倒造成的损伤是老年人并发症和死亡的主要因素。尽管有效性试验的证据表明许多跌倒是可以预防的，但导致跌伤的比率并没有下降。方法我们进行了一项务实的整群随机试验，以评估多因素干预的有效性，其中包括风险评估和由受过专门培训的护士实施的个性化计划，以预防跌伤。共有10个医疗保健系统的86个初级保健诊所被随机分配到干预组或加强常规护理组(对照组)(每个诊所43个诊所)。参与者是居住在社区的成年人，70岁或以上，他们摔倒受伤的风险更高。在事件发生时间分析中评估的主要结果是第一次严重坠落伤害，通过使用参与者报告、电子健康记录和索赔数据进行判断。我们假设干预组的事件发生率比对照组低20%。结果干预组(2802名参与者)和对照组(2649名参与者)的人口统计学和基线特征相似，平均年龄为80岁，62.0%的参与者是女性。根据首次事件发生时间分析(每100人年的随访事件，干预组为4.9，对照组为5.3；危险比，0.92；95%可信区间[CI]，0.80至1.06；P=0.25)，两组之间首次判定的严重坠落伤率没有显著差异。第一参与者报告的坠落损伤发生率在干预组为25.6次/百人年，对照组为28.6次/百人年(危险比为0.9；95%可信区间为0.83~0.99；P=0.004)。两组的住院率和死亡率相似。结论由护士实施的多因素干预不会导致首次判定为严重坠落伤的比率明显低于加强常规护理。(由以患者为中心的结果研究所和其他机构资助；Stride ClinicalTrials.gov编号，NCT02475850。)跌倒造成的伤害是老年人死亡和并发症的主要原因。在这项务实的整群随机试验中，由护士实施的多因素干预并未导致首次判定为严重跌伤的比率明显低于加强常规护理。
BackgroundInjuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of falls resulting in injury have not declined.MethodsWe conducted a pragmatic, cluster-randomized trial to evaluate the effectiveness of a multifactorial intervention that included risk assessment and individualized plans, administered by specially trained nurses, to prevent fall injuries. A total of 86 primary care practices across 10 health care systems were randomly assigned to the intervention or to enhanced usual care (the control) (43 practices each). The participants were community-dwelling adults, 70 years of age or older, who were at increased risk for fall injuries. The primary outcome, assessed in a time-to-event analysis, was the first serious fall injury, adjudicated with the use of participant report, electronic health records, and claims data. We hypothesized that the event rate would be lower by 20% in the intervention group than in the control group.ResultsThe demographic and baseline characteristics of the participants were similar in the intervention group (2802 participants) and the control group (2649 participants); the mean age was 80 years, and 62.0% of the participants were women. The rate of a first adjudicated serious fall injury did not differ significantly between the groups, as assessed in a time-to-first-event analysis (events per 100 person-years of follow-up, 4.9 in the intervention group and 5.3 in the control group; hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P=0.25). The rate of a first participant-reported fall injury was 25.6 events per 100 person-years of follow-up in the intervention group and 28.6 events per 100 person-years of follow-up in the control group (hazard ratio, 0.90; 95% CI, 0.83 to 0.99; P=0.004). The rates of hospitalization or death were similar in the two groups.ConclusionsA multifactorial intervention, administered by nurses, did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care. (Funded by the Patient-Centered Outcomes Research Institute and others; STRIDE ClinicalTrials.gov number, NCT02475850.)Injuries from falls are major contributors to death and complications in older adults. In this pragmatic, cluster-randomized trial, a multifactorial intervention that was administered by nurses did not result in a significantly lower rate of first adjudicated serious fall injury than enhanced usual care.