Abstract

Objective: 

To explore the incidence of falls and associated risk factors in the first year after hospital discharge in survivors of critical illness.探讨重症监护幸存者出院后第一年内跌倒的发生率及相关危险因素。

Design: 

Prospective single-site observational study.前瞻性单中心观察性研究。

Setting: 

University-affiliated mixed ICU.大学附属综合性重症监护室（ICU）

Patients: 

One hundred ICU adults who required invasive ventilation for 48 hours and in an ICU for at least 4 days.100名需要侵入性通气48小时且在ICU住院至少4天的成人ICU患者

Interventions: 

Not applicable.不适用

Measurements and Main Results: 

Falls were monitored prospectively for 1 year with completion of monthly falls calendars. Falls data included the number of people who had falls/no falls/recurrent falls, falls rate per person per year, and time to first fall. Fall severity was classified according to the Schwenck classification scheme to examine injurious falls requiring medical intervention. Other outcomes considered included assessments of balance, strength, function, cognition, psychologic health, and health-related quality of life. One hundred participants (31% female) were recruited with a mean age of 58.3 ± 16.2 years, and a median ventilation duration of 6.3 days [4.0–9.1]. Sixty-one percent fell at least once in the first year with the majority sustaining two or more falls (81.4%) and one in four sustained an injurious fall requiring medical attention. The falls incidence rate was 4.4 falls per person-year (95% CI, 3.2–5.9), with the highest incidence occurring less than 3 months after hospital discharge (5.9 falls/person-year [95% CI, 4.4–7.8]). Time to first fall or injurious fall was 36 [11–66] and 95 (95% CI, 40–155) days, respectively. Key risk factors for falls at the time of hospital discharge include comorbidities, higher discharge medications, balance, and muscle strength.通过每月填写跌倒日历的方式对跌倒情况进行为期1年的前瞻性监测。跌倒数据包括有跌倒/无跌倒/反复跌倒的人数、每人每年跌倒率以及首次跌倒的时间。根据Schwenck分类方案对跌倒严重程度进行分类，以检查需要医疗干预的受伤性跌倒。其他考虑的结果包括平衡、力量、功能、认知、心理健康和健康相关生活质量的评估。共招募了100名参与者（女性占31%），平均年龄为58.3±16.2岁，中位通气时间为6.3天[4.0-9.1]。61%的参与者在出院后第一年内至少跌倒一次，其中大多数经历过两次或更多次跌倒（81.4%），四分之一的人经历了需要医疗关注的受伤性跌倒。跌倒发生率为每人每年4.4次（95%置信区间[CI]，3.2-5.9），其中出院后不到3个月内的发生率最高（5.9次/人年[95% CI, 4.4–7.8]）。首次跌倒或受伤性跌倒的时间分别为36天[11-66]和95天（95% CI, 40-155）。出院时跌倒的关键危险因素包括合并症、较高的出院用药量、平衡能力和肌肉力量。

Conclusions: 

There was a high falls incidence in ICU survivors. The study findings suggest a critical window may exist within the first 3 months after hospital discharge and the need for screening, pharmacological optimization, and exercise training in this patient group.ICU幸存者的跌倒发生率很高。研究结果表明，出院后前3个月可能存在一个关键窗口期，这一患者群体需要进行筛查、药物优化和运动训练。