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老年主要创伤患者死亡率的预测因素
Krishan Yadav1,2,3, Jacinthe Lampron4,5, Richard Nadj6
1Department of Emergency Medicine, Clinical Epidemiology Unit F660b, University of Ottawa, Ottawa, ON, Canada. kyadav@toh.ca.
CJEM
|September 24, 2023
概括
年长的创伤患者面临更高的死亡率和低选率. 关键的死亡因素包括低格拉斯哥昏迷量表 (GCS) 评分,高伤害严重程度评分 (ISS),晚年 (≥85),抗凝血和多病症,需要更新创伤激活标准.
科学领域:
- 创伤外科 手术 创伤外科
- 老年医学 老年医学
- 紧急医疗 紧急医疗
背景情况:
- 与年轻人相比,老年人经历创伤后的死亡率更高.
- 目前的创伤队激活标准对于老年创伤患者来说往往不理想,导致选不足.
- 老年创伤患者由于与年龄相关的生理变化和并发症而面临独特的挑战.
研究的目的:
- 描述老年人 (≥65岁) 的创伤护理和结果.
- 在这个人口群体中,独立地确定与30天死亡率相关的因素.
- 为改善老年患者创伤激活标准的开发提供信息.
主要方法:
- 从2014年到2020年,对老年创伤患者 (≥65岁) 的追溯健康记录审查.
- 纳入标准:伤害严重性评分 (ISS) >12,创伤小组激活或创伤病房入院.
- 多变量逻辑回归分析了与30天全因死亡率相关的因素,使用多重归算缺失的数据.
主要成果:
- 分析了1380名老年患者 (平均年龄80岁);17.3%的患者经历了30天死亡率.
- 与死亡率增加显著相关的因素:GCS<15,ISS>15,年龄≥85,使用抗凝血剂 (DOAC/华法林) 和多病症.
- 痴呆和延迟的CT扫描 (>60分钟) 与死亡风险降低有关.
结论:
- 在老年创伤患者中,五个关键因素预测了30天死亡率的增加:GCS<15,ISS>15,年龄≥85,抗凝血和多病症.
- 这些发现对于完善老年人群的创伤组激活协议至关重要.
- 优化标准可以改善老年创伤受害者及时和适当的护理.
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