| BackgroundWith the acceleration of the global aging process,the absolute number and proportion of the elderly population(>=60 years old)have been increasing.The decline of physiological function and increase of mental disease caused by the increase of age has made the elderly group gradually become the main population in medical activities.Data from the National Trauma Data Bank(NTDB)shows that the proportion of elderly patients in emergency treatment activities such as trauma first aid is increasing.For elderly patients,in addition to the main clinical diagnosis,physical and psychological states such as hypertension,diabetes,and dementia can increase the risk of adverse outcomes to varying degrees.At present,research on the frailty of the elderly has been carried out abroad,and it has been proven that it can be used to predict the inpatient complications,discharges and mortality of elderly patients.Frailty refers to a decline in physical protection and an increase in the possibility of disability.At present,most of the existing frailty assessment methods are in the form of questionnaires,which need to be filled in manually,and is time consuming and is easily affected by various biases.The purpose of this study was to investigate whether it is possible to construct an elderly trauma frailty index based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems(ICD-10).Purpose and SignificanceThe investigation was carried out on the hospitals in Shanghai Central Trauma Emergency Medical Association.First,the medical records of elderly trauma patients were collected to build a database,including demographic characteristics,hospitalization characteristics and injury diagnosis.And we explored the differences of injuries characteristics between urban and rural elderly trauma patients.This is helpful to systematically sort out the injuy characteristics of elderly trauma patients.Second,we use statistical methods to construct the elderly trauma frailty index based on ICD-10,and determine the boundary value to distinguish the frail and non-frail to complete the purpose for evaluating frailty of elderly trauma patients.Third,retrospective analysis was carry out on the effect of elderly trauma frailty index predicting the outcome of hospitalized patients.And we compared the elderly trauma frailty index with the existing frailty assessment methods to evaluate the effectiveness of it.Materials and MethodsFirst,we collected the medical records of elderly trauma inpatients from 2015 to 2018 in 11 hospitals in the Shanghai Central Trauma Emergency Medical Association and constructed the database.Descriptive analysis was used to analyze the composition of elderly trauma patients from three aspects:demographic characteristics,hospitalization characteristics and injury diagnosis.Based on ICD-10,the patients’Frailty Syndrome and Charlson comorbidity index Score were calculated.We also explored the differences of injuries characteristics between urban and rural elderly trauma patients.Second,we completed the elderly trauma frailty index.Ward systematic cluster analysis,Logistic regression,ROC curve and other methods were used to identify frail groups.The ICD-10 that affects the frailty of elderly trauma patients were filtered and assigned.And the boundary value of the frail and non-frail was clearly distinguished.Third,the ROC curve analysis was used to retrospectively analyze the effects of the elderly trauma frailty index to predict outcomes such as discharges and length of stay.The Kappa consistency test was used to compare the elderly trauma frailty index and Fried frailty scale,trauma specific frailty index,and modified frailty index of the same group of patients to verify the effectiveness.Results and Conclusions(1)Analysis of injury characteristics on elderly trauma population.From aspect of overall analysis,the number of elderly female patients is more than elderly male patients.It is believed that elderly women are more likely to fall and get injured than elderly men.The injury areas are mainly lower extremities and head,and attention should be paid to lower extremities and head injuries of elderly trauma patients.Falls and motor and non-motor vehicle traffic accidents are the main injury causes of elderly trauma patients.When elderly people go out,they should pay attention to avoid falls and traffic accidents.Judging from the analysis of the injury characteristics on the elderly trauma patients in urban and rural medical institutions,the elderly trauma patients in urban medical institutions were mainly admitted to the hospital in the "emergency" mode.They were older,had longer hospital stays,higher total costs,and higher Charlson Index,more basic diseases such as hypertension.Elderly trauma patients in rural medical institutions are mainly admitted as "outpatients",and patients are more likely to choose surgery.This is of great significance to the medical institutions in different regions in the treatment options and treatment strategies for elderly trauma patients.(2)Construction of Elderly Trauma Frailty Index.Based on the collection of medical records and the analysis of injury characteristics of elderly trauma patients,according to Ward system cluster analysis,Logistic regression analysis,ROC curve and other methods,the frail group of elderly trauma patients was determined.The ICD-10 diagnostic codes that affects the frailty of elderly trauma patients were screened.The score of ICD-10 diagnostic codes were completed,including G30 Alzheimer’s disease(1.025),G82 paraplegia and quadriplegia(1.221),180 phlebitis and thrombophlebitis(0.170),J96 respiratory failure,unclassifiable elsewhere(0.971),K81 cholecystitis(0.304),M41 scoliosis[scoliosis](1.010),M43 other deformable back disease(0.628),M47 spinal joint stiffness(0.601),M53 other back disease,can not be classified elsewhere(0.903),S72 Femoral fractures(1.609),other injuries to the spine and torso at T09,level not specifically 0.666),W01 slips,trips and falls on the same plane(1.901),W06 involves a fall on the bed(1.665),W10 on the stairs Or falls and steps on the steps(1.442),W13 falls or falls from the house or building structure(2.915),W17 other falls from one plane to another(2.462),W18 other falls on the same plane(1.114),Z50 involves medical use of rehabilitation operations(0.004),Z90 organs are born with a lack of organs and cannot be classified elsewhere(1.422),Z92 medical personal history(0.832),Z95 has heart and vascular implants and grafts(0.352),Z98 state after surgery(1.166).Finally,the ROC curve analysis was performed to verify the effectiveness of the Elderly Trauma Frailty Index to determine the frailty of elderly trauma patients.The area under the curve is 0.759(0.750-0.767),the sensitivity is 0.699,the specificity is 0.769,the Youden index is 0.468,and the index bound is 0.749.It will provide a basis for further verification of the effectiveness of Elderly Trauma Frailty Index.(3)Verification of Elderly Trauma Frailty Index.This section conducted a verification study on Elderly Trauma Frailty Index from the analysis of the injury characteristics of patients in different groups,the prediction of patient outcomes,and comparison with other frailty index.Analysis of the injury characteristics of patients in different groups found that with the increase of age,the proportion of "emergency"admissions increased,the surgical rate decreased,Charlson Index and Elderly Trauma Frailty Index increased;at the same time,frail patients(>0.749)have longer length of stay,higher Charlson Index,and higher proportion of at least one Frailty Syndrome,indicating that Elderly Trauma Frailty Index can reflect the frailty of elderly trauma patients.Study on the prediction of patient outcomesfound that Elderly Trauma Frailty Index is related to patient’s outcome.The higher the index,the longer the length of stay and the worse the discharge;when Elderly Trauma Frailty Index combined with the patient’s personal characteristics,the predicting effect of the index on length of stay was average(AUC=0.670),and the effect of discharge was good(AUC=0.799);compared with the predicting effect of the Frailty Syndrome on length of stay and discharge(AUC=0.590,0.792),the effect of Elderly Trauma Frailty Index is better.Compared with other frailty indexs,it is found that the consistency between Elderly Trauma Frailty Index and other frailty indexs is no good.The main reasons are:①frailty indexes were constructed according to different concepts of frailty,reflecting different perspectives of patients’frailty;② Most of the frailty indexs cannot be converted each other.It is suggested that the construction of frailty assessment methods is still challenging.This study provides new ideas for the subsequent research on frailty assessment methods to build a frailty index based on the daily medical records of hospitals.In general,the ICD-10-based Elderly Trauma Frailty Index is still inadequate,but its advantage is that the frailty of patients can be directly obtained from the International Classification of Diseases and Related Health Problems Statistical Classification(ICD-10)code.Therefore,it can be used in the hospital electronic medical record system,and it can eliminate the burden of implementing manual scoring,and is more suitable for emergency treatment patients such as trauma.This study also provides new ideas for the subsequent research on frailty assessment methods to construct a frailty index from the perspective of hospital electronic medical records.Policy Suggestions(1)The compilation of data of elderly trauma patients should be payed attention.In the treatment of elderly trauma patients,attention should be paid to head trauma,lower limb trauma,elderly female patients,and poor outcomes caused by basic diseases such as hypertension.In terms of health education,we need to pay attention to the occurrence of falls and non-motor vehicle traffic accidents in the elderly,and increase personal awareness to avoid these.At the same time,urban and rural medical institutions’treatment options and treatment strategies for the elderly trauma patients should be payed attention.(2)The Elderly Trauma Frailty Index can directly obtain the patient’s frailty from the ICD-10 diagnostic code,and can be used in the hospital electronic medical record system,which can eliminate the implementation burden of manual scoring,and is more suitable for emergency treatment patients such as trauma.(3)The study provides new ideas for the subsequent research on frailty assessment methods to construct a frailty index from the perspective of hospital electronic medical records. |
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