Superiority of Frailty Over Age in Predicting Outcomes Among Geriatric Trauma Patients A Prospective Analysis
Superiority of Frailty Over Age in Predicting Outcomes Among Geriatric Trauma Patients A Prospective Analysis
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DOI：
10.1001/jamasurg.2014.296
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发表时间：
2014-08-01
期刊：
影响因子：
16.9
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
重要性虚弱指数(FI)是老年患者不良结局的已知预测因子。目的评估FI作为预测老年创伤患者不良结局的有效评估工具的有效性。设计、背景和参与者在亚利桑那大学I级创伤中心进行的一项为期两年(2011年6月至2013年2月)的前瞻性队列研究。我们前瞻性地测量了所有老年创伤患者的虚弱程度。老年病患者被定义为65岁或以上的患者。使用50个入院前脆弱变量计算FI。患者的脆弱程度由FI为0.25或更高来定义。主要结果和衡量标准是住院期间的并发症。次要结果衡量指标是不良的出院倾向。住院并发症定义为心脏、肺部、感染、血液病、肾脏和再手术。不良出院处置被定义为出院到熟练护理机构或住院死亡率。结果250例患者的平均年龄(SD)为77.9(8.1)岁，平均损伤严重程度评分为15(9~18)分，格拉斯哥昏迷评分中位数为15(12~15)分，平均(SD)FI为0.21(0.10)。44%(n=110)的患者身体虚弱。虚弱的患者更有可能出现住院并发症(优势比，2.5；95%可信区间，1.5-6.0；P=.001)和不良的出院倾向(优势比，1.6；95%可信区间，1.1-2.4；P=.001)。病死率为2.0%(n=5)，所有死亡的患者都有虚弱。结论FI是老年创伤患者院内并发症和不良出院倾向的独立预测因子。这一指标应作为该患者组风险分层的临床工具。
IMPORTANCE The Frailty Index (FI) is a known predictor of adverse outcomes in geriatric patients. The usefulness of the FI as an outcome measure in geriatric trauma patients is unknown.OBJECTIVE To assess the usefulness of the FI as an effective assessment tool in predicting adverse outcomes in geriatric trauma patients.DESIGN, SETTING, AND PARTICIPANTS A 2-year (June 2011 to February 2013) prospective cohort study at a level I trauma center at the University of Arizona. We prospectively measured frailty in all geriatric trauma patients. Geriatric patients were defined as those 65 years or older. The FI was calculated using 50 preadmission frailty variables. Frailty in patients was defined by an FI of 0.25 or higher.MAIN OUTCOMES AND MEASURES The primary outcome measure was in-hospital complications. The secondary outcome measure was adverse discharge disposition. In-hospital complications were defined as cardiac, pulmonary, infectious, hematologic, renal, and reoperation. Adverse discharge disposition was defined as discharge to a skilled nursing facility or in-hospital mortality. Multivariate logistic regression was used to assess the relationship between the FI and outcomes.RESULTS In total, 250 patients were enrolled, with a mean (SD) age of 77.9 (8.1) years, median Injury Severity Score of 15 (range, 9-18), median Glasgow Coma Scale score of 15 (range, 12-15), and mean (SD) FI of 0.21 (0.10). Forty-four percent (n = 110) of patients had frailty. Patients with frailty were more likely to have in-hospital complications (odds ratio, 2.5; 95% CI, 1.5-6.0; P = .001) and adverse discharge disposition (odds ratio, 1.6; 95% CI, 1.1-2.4; P = .001). The mortality rate was 2.0% (n = 5), and all patients who died had frailty.CONCLUSIONS AND RELEVANCE The FI is an independent predictor of in-hospital complications and adverse discharge disposition in geriatric trauma patients. This index should be used as a clinical tool for risk stratification in this patient group.