【罂粟摘要】多系统创伤后虚弱与不良结局的关系:一项系统综述和Meta分析
多系统创伤后虚弱与不良结局的关系:一项系统综述和Meta分析
翻译：潘志军 编辑：佟睿 审校：曹莹
贵州医科大学高鸿教授课题组
在各种临床环境中，患者的虚弱状态有力地预示着不良结局；然而，与虚弱相关的创伤结局尚未得到系统综述和定量综合。我们的目标是系统综述和Meta分析多系统创伤后虚弱和结局之间的关系(死亡率-首要；并发症、卫生资源使用情况和患者体验-次要）。
注册(CRD42018104116)后，我们应用同行评审的搜索策略对MEDLINE、EMBASE以及护理和相关健康文献综合索引(CINAHL)从成立到2019年5月22日的文献进行了检索，以确定所描述的研究包括：(1)多系统创伤；(2)参与者≥18岁；(3)明显虚弱的测量工具；(4)相关结局。排除的研究包括：(1)缺乏比较组；(2)报告的孤立伤害；(3)报道的混合创伤和非创伤人群。标准独立适用，对标题/摘要和全文一式两份。使用非随机干预研究中的偏倚风险(ROBINS-I)工具评估偏倚风险。使用随机效应模型将效应测量（针对预先指定的混杂因素进行调整）合并；否则，使用叙事合成。
纳入了16项包含5198名参与者的研究；虚弱者的死亡率为9.9%，而非虚弱者则为4.2%。虚弱与死亡率(调整优势比[OR]，1.53；95%置信区间[CI]，1.37–1.71)，并发症(调整后OR，2.32；95%置信区间，1.72–3.15)和不良出院(调整后的OR，1.78；95%置信区间，1.29–2.45)增加相关。很少报告患者功能、体验和资源使用情况。
虚弱的存在与多系统创伤后的死亡率、并发症和不良出院处置显著相关。这为与患者和家属的讨论提供了重要的预后信息，并强调了创伤系统优化以满足老年患者复杂需求的必要性。
Alexander Poulton, Julia F . Shaw, Frederic Nguyen, et al. The Association of Frailty With Adverse Outcomes After Multisystem Trauma: A Systematic Review and Meta-analysis.[J]. (Anesth Analg 2020;130:1482–92).
The Association of Frailty With Adverse Outcomes After Multisystem Trauma: A Systematic Review and Meta-analysis
Abstract
Background: Frailty strongly predicts adverse outcomes in a variety of clinical settings; however, frailty-related trauma outcomes have not been systematically reviewed and quantitatively synthesized. Our objective was to systematically review and meta-analyze the association between frailty and outcomes (mortality-primary; complications, health resource use, and patient experience-secondary) after multisystem trauma.
Methods: After registration (CRD42018104116), we applied a peer-reviewed search strategy to MEDLINE, EMBASE, and Comprehensive Index to Nursing and Allied Health Literature (CINAHL) from inception to May 22, 2019, to identify studies that described: (1) multisystem trauma; (2) participants ≥18 years of age; (3) explicit frailty instrument application; and (4) relevant outcomes. Excluded studies included those that: (1) lacked a comparator group; (2) reported isolated injuries; and (3) reported mixed trauma and nontrauma populations. Criteria were applied independently, in duplicate to title/abstract and full-text articles. Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) tool. Effect measures (adjusted for prespecified confounders) were pooled using random-effects models; otherwise, narrative synthesis was used.
Results: Sixteen studies were included that represented 5198 participants; 9.9% of people with frailty died compared to 4.2% of people without frailty. Frailty was associated with increased mortality (adjusted odds ratio [OR], 1.53; 95% confidence interval [CI], 1.37–1.71), complications (adjusted OR, 2.32; 95% CI, 1.72–3.15), and adverse discharge (adjusted OR, 1.78; 95% CI, 1.29–2.45). Patient function, experience, and resource use outcomes were rarely reported.
Conclusions: The presence of frailty is significantly associated with mortality, complications, and adverse discharge disposition after multisystem trauma. This provides important prognostic information to inform discussions with patients and families and highlights the need for trauma system optimization to meet the complex needs of older patients.