Objective: To explore the relationship between frailty and adverse outcomes in older trauma patients in the emergency department.
Methods: A prospective cohort study was conducted. Older trauma patients admitted to the emergency department of three tertiary-care hospitals in Chengdu between January 2021 and August 2021 were enrolled. The patients were divided into a frailty group and a non-frailty group according to their assessment results for Trauma-Specific Frailty Index (TSFI). The end points, including falls, readmission, and deaths, were documented during the 6-month follow-up. Cox risk regression model was used to analyze the relationship between frailty and adverse outcomes in older trauma patients in the emergency department.
Results: A total of 375 older trauma patients in the emergency department were enrolled, including 131 in the frailty group and 244 in the non-frailty group. After 6 months of follow-up, the incidences of falls, readmission and deaths in older trauma patients in the emergency department were 18.93%, 14.40%, and 7.73%, respectively. The incidences of falls (28.24% vs. 13.93%, P=0.001), readmission (25.95% vs. 8.20%, P=0.000), and deaths (12.98% vs. 4.92%, P=0.005) in older trauma patients in the emergency department in the frailty group were higher than those in the non-frailty group. After adjusting for multiple confounding factors using the Cox regression model, the risks of falls (hazard ratio [ HR]=1.859, 95% confidence interval [ CI]: 1.070-3.230, P=0.028] and readmission ( HR=2.920, 95% CI: 1.537-5.547, P=0.001) were higher in the frailty group than those in the non-frailty group, but there was no significant difference in the risk of deaths between the frailty group and the non-frailty group.
Conclusion: Frailty is a risk factor for falls and readmissions in older trauma patients in the emergency department and the association between frailty and the risk of deaths in older trauma patients in the emergency department needs to be validated by further studies.
目的: 探讨衰弱与急诊老年创伤患者不良结局预后的关系。
方法: 采用前瞻性队列研究设计，纳入2021年1–8月在成都市3所三甲医院急诊科收治的老年创伤患者，按照中文版创伤特异性衰弱指数（Trauma Specific Frailty Index, TSFI）评估结果分为衰弱组和非衰弱组，并记录6个月随访的终点事件（跌倒、再入院和死亡）。采用Cox风险回归模型分析衰弱与急诊老年创伤患者不良结局的关系。
结果: 共纳入375例急诊老年创伤患者，其中衰弱组131例，非衰弱组244例。随访6个月后，急诊老年创伤患者跌倒、再入院、死亡事件的发生率分别为18.93%、14.40%、7.73%。衰弱组急诊老年创伤患者跌倒（28.24% vs. 13.93%，P=0.001）、再入院（25.95% vs. 8.20%，P=0.000）、死亡（12.98% vs. 4.92%，P=0.005）的发生率均高于非衰弱组。应用Cox风险回归模型调整混杂因素以后，衰弱组发生跌倒〔风险比（hazard ratio, HR）=1.859，95%置信区间（confidence interval, CI）：1.070～3.230，P=0.028〕和再入院（HR=2.920，95%CI：1.537～5.547，P=0.001）的风险均高于非衰弱组，衰弱组和非衰弱组发生死亡的风险无明显差异。
结论: 衰弱是急诊老年创伤患者发生跌倒和再入院的危险因素，衰弱与急诊老年创伤患者发生死亡的风险的相关性需进一步研究。
Keywords: Emergency department; Frailty; Older adults; Prognosis; Prospective cohort study; Trauma.
Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).