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Health Services Use and Functional Recovery Following Blunt Trauma in Older Persons - A National Multicentre Prospective Cohort Study.

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Date
2021-11-27
Authors
Wong, Ting-Hway
Tan, Timothy Xin Zhong
Malhotra, Rahul
Nadkarni, Nivedita V
Chua, Wei Chong
Loo, Lynette Ma
Iau, Philip Tsau Choong
Ang, Arron Seng Hock
Goo, Jerry Tiong Thye
Chan, Kim Chai
Matchar, David Bruce
Seow, Dennis Chuen Chai
Nguyen, Hai V
Ng, Yee Sien
Chan, Angelique
Fook-Chong, Stephanie
Tang, Tjun Yip
Ong, Marcus Eng Hock
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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.
Type
Journal article
Subject
Geriatric trauma
blunt trauma
frailty
modified Fried criteria
time at home
Permalink
https://hdl.handle.net/10161/24181
Published Version (Please cite this version)
10.1016/j.jamda.2021.10.016
Publication 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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Scholars@Duke

Matchar

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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