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Patients with hip fracture admitted to critical care: epidemiology, interventions and outcome.
Gibson, Alistair A; Hay, Alasdair W; Ray, David C.
Afiliação
  • Gibson AA; Department of Anaesthesia & Critical Care, Royal Infirmary of Edinburgh, United Kingdom.
  • Hay AW; Department of Critical Care, Royal Infirmary of Edinburgh, United Kingdom.
  • Ray DC; Department of Anaesthesia & Critical Care, Royal Infirmary of Edinburgh, United Kingdom. Electronic address: david.ray@luht.scot.nhs.uk.
Injury ; 45(7): 1066-70, 2014 Jul.
Article em En | MEDLINE | ID: mdl-24680801
INTRODUCTION: Although there is much current debate about the use of critical care to enhance peri-operative care of patients with hip fracture there are limited supporting data. We investigated the epidemiology, critical care interventions and outcomes of patients with hip fracture admitted to a large UK critical care unit. PATIENTS AND METHODS: We reviewed all patients with hip fracture (excluding those with multiple trauma, and those with femoral shaft or peri-prosthetic fracture) who were admitted to our critical care unit during a four year period. We recorded patient characteristics, reason for admission to critical care, interventions and organ support performed, and patient outcome. RESULTS: We identified 99 patients with a mean age of 81 years; this represented 1% of patients admitted to critical care, and 2.4% of patients with hip fracture admitted to hospital during the study period. Fifty-two patients required no organ support; 19 received only respiratory support, 13 only cardiovascular support, 12 received both respiratory and cardiovascular support, and 3 received respiratory, cardiovascular and renal support. Outcome worsened as the level of organ support increased (p=0.01). Fifteen patients died in critical care, acute hospital mortality was 33% and 1-year mortality was 54%. No patient for whom admission was planned before surgery died in critical care and the 30-day mortality for this group was 13%. Outcome was related to the time between surgery and critical care admission: patients admitted before surgery or longer than 2 days after surgery had worse outcomes (p=0.001). The reason for admission to critical care also influenced outcome: patients with sepsis had poor outcome with one-third dying in critical care and a further one-third not surviving to hospital discharge. CONCLUSIONS: The major determinants of outcome in this population were reason for admission, and timing of admission to critical care. One year survival was better than that for unselected patients aged >80 years admitted to critical care. Admission to critical care and use of enhanced peri-operative care for selected hip fracture patients is entirely appropriate and beneficial.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cuidados Críticos / Fraturas do Quadril / Hospitalização Tipo de estudo: Prognostic_studies / Screening_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cuidados Críticos / Fraturas do Quadril / Hospitalização Tipo de estudo: Prognostic_studies / Screening_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Ano de publicação: 2014 Tipo de documento: Article