虚弱是否会影响老年创伤患者的救援失败?
Mitsuaki Kojima1, Koji Morishita, Tomohisa Shoko
1From the Emergency and Critical Care Center (M.K., T.S.), Tokyo Women's Medical University Adachi Medical Center, Adachi, Tokyo, Japan; Trauma and Acute Critical Care Medical Center (K.M.), Tokyo Medical and Dental University Hospital, Bunkyo, Tokyo, Japan; CECORC-Comparative Effectiveness and Clinical Outcomes Research Center (B.Z., R.C.), Riverside University Health System Medical Center, Moreno Valley, CA; and Division of Trauma, Surgical Critical Care (TC, LH), Burns, and Acute Care Surgery, Department of Surgery, University of California San Diego Health Sciences, San Diego, CA.
在老年创伤患者中,脆弱性显著增加了失败救援 (FTR) 的风险. 医疗保健提供者在评估创伤护理质量时应考虑患者的脆弱性.
科学领域:
- 老年人创伤护理 创伤护理
- 创伤外科手术中的质量指标
- 患者脆弱性的评估
背景情况:
- 失败救援 (FTR) 是创伤护理质量的关键指标,定义为重大并发症后的死亡.
- 患者虚弱对FTR的影响,特别是在老年创伤人群中,仍未得到充分研究.
- 这项研究调查了脆弱性加剧严重受伤的老年人FTR的风险的假设.
研究的目的:
- 确定患者的脆弱性是否是老年创伤患者失败救援 (FTR) 的独立预测因素.
- 使用大型创伤注册表分析脆弱性和FTR之间的关联.
- 为提高老年创伤护理的质量提供信息.
主要方法:
- 使用TQIP数据库 (2015-2019) 进行的回顾性队列研究.
- 包括老年创伤患者 (年龄≥65岁),受伤严重程度评分 (ISS) >15,生存时间≥48小时.
- 使用修改的5项脆弱指数 (mFI) 评估脆弱性;患者被分为脆弱 (mFI ≥2) 或非脆弱 (mFI <2) 的患者.
- 后勤回归和通用添加模型 (GAM) 分析了FTR风险,控制了混因素.
主要成果:
- 该队列包括52312名老年创伤患者;34.6%被确定为脆弱.
- 虚弱的患者表现出更高的FTR发病率 (8.7%对8.0%,p = 0.006).
- 脆弱性独立预测FTR (OR,1.32;95% CI,1.23-1.44;p < 0.001),随着mFI的上升观察到FTR风险的线性增加.
结论:
- 脆弱性是老年创伤患者无法救援的独立风险因素.
- 修改后的5项脆弱性指数 (mFI) 有效地识别了较高风险的脆弱患者.
- 将脆弱性评估纳入质量指标是优化老年创伤护理的关键.
相关概念视频
Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
Acute Respiratory Failure-IV
Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Pathophysiology of Heart Failure
Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...


