Health Services Use and Functional Recovery Following Blunt Trauma in Older Persons - A National Multicentre Prospective Cohort Study.
Abstract
<h4>Objective</h4>Frailty is associated with morbidity and mortality in older injured
patients. However, for older blunt-trauma patients, increased frailty may not manifest
in longer length of stay at index admission. We hypothesized that owing to time spent
in hospital from readmissions, frailty would be associated with less total time at
home in the 1-year postinjury period.<h4>Design</h4>Prospective, nationwide, multicenter
cohort study.<h4>Setting and participants</h4>All Singaporean residents aged ≥55 years
admitted for blunt trauma with an Injury Severity Score (ISS) or New Injury Severity
Score (NISS) ≥10 from March 2016 to July 2018.<h4>Methods</h4>Frailty (by modified
Fried criteria) was assessed at index admission, based on questions on preinjury weight
loss, slowness, exhaustion, physical activity, and grip strength at the time of recruitment.
Low time at home was defined as >14 hospitalized days within 1 year postinjury. The
contribution of planned and unplanned readmission to time at home postinjury was explored.
Functional trajectory (by Barthel Index) over 1 year was compared by frailty.<h4>Results</h4>Of
the 218 patients recruited, 125 (57.3%) were male, median age was 72 years, and 48
(22.0%) were frail. On univariate analysis, frailty [relative to nonfrail: odds ratio
(OR) 3.45, 95% confidence interval (CI) 1.33-8.97, P = .01] was associated with low
time at home. On multivariable analysis, after inclusion of age, gender, ISS, intensive
care unit admission, and surgery at index admission, frailty (OR 5.21, 95% CI 1.77-15.34,
P < .01) remained significantly associated with low time at home in the 1-year postinjury
period. Unplanned readmissions were the main reason for frail participants having
low time at home. Frail participants had poorer function in the 1-year postinjury
period.<h4>Conclusions and implications</h4>In the year following blunt trauma, frail
older patients experience lower time at home compared to patients who were not frail
at baseline. Screening for frailty should be considered in all older blunt-trauma
patients, with a view to being prioritized for postdischarge support.
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https://hdl.handle.net/10161/24181Published Version (Please cite this version)
10.1016/j.jamda.2021.10.016Publication Info
Wong, Ting-Hway; Tan, Timothy Xin Zhong; Malhotra, Rahul; Nadkarni, Nivedita V; Chua,
Wei Chong; Loo, Lynette Ma; ... Ong, Marcus Eng Hock (2021). Health Services Use and Functional Recovery Following Blunt Trauma in Older Persons
- A National Multicentre Prospective Cohort Study. Journal of the American Medical Directors Association. 10.1016/j.jamda.2021.10.016. Retrieved from https://hdl.handle.net/10161/24181.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
David Bruce Matchar
Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical
policies to their implementation in real world clinical settings. Most recently my
major content focus has been cerebrovascular disease. Other major clinical areas in
which I work include the range of disabling neurological conditions, cardiovascular
disease, and cancer prevention. Notable features of my work are: (1) reliance on
analytic strategies such as meta-analysis, simulation, decision analy

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