Association of the Geriatric Nutritional Risk Index and Prognostic Nutritional Index With Short-Term Clinical Outcomes in Older Adults With Multiple Rib Fractures Presenting to the Emergency Department After Isolated Blunt Thoracic Trauma: A Prospective Observational Cohort Study
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 294
- 试验地点
- 2
- 主要终点
- Composite In-Hospital Adverse Outcome in Older Adults With Multiple Rib Fractures
研究概览
简要总结
This prospective observational cohort study will evaluate whether the Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) can predict short-term clinical outcomes in adults aged 65 years or older with isolated blunt thoracic trauma and more than three rib fractures. Participants will be enrolled in the Emergency Department of Ankara Etlik City Hospital. No experimental drug, device, or additional invasive procedure will be used. Routine clinical, laboratory, anthropometric, imaging, and follow-up data will be recorded. The study plans to include 294 participants. The primary outcome is a composite short-term poor clinical outcome, including in-hospital mortality, intensive care unit admission, invasive or non-invasive mechanical ventilation, pneumonia, atelectasis, tube thoracostomy, or hospital stay of 7 days or longer. The prognostic performances of GNRI and PNI will be compared. Secondary outcomes include the individual components of the composite outcome, new pneumothorax or hemothorax, hospital and intensive care unit length of stay, 30-day emergency department revisit, and 30-day mortality.
详细描述
Older adults with multiple rib fractures may have an increased risk of respiratory complications, intensive care admission, prolonged hospitalization, and mortality after thoracic trauma. Nutritional impairment may contribute to this risk through reduced respiratory muscle strength and impaired immune response. The Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) are practical nutritional assessment tools calculated from routinely available clinical and laboratory data.
This is a prospective, single-center, observational cohort study conducted in the Emergency Department of Ankara Etlik City Hospital. The study will include adults aged 65 years or older who present with isolated blunt thoracic trauma and more than three radiologically confirmed rib fractures. Patients will be evaluated during routine clinical care, and no additional treatment, medication, device, or invasive procedure will be administered for research purposes.
GNRI will be calculated using serum albumin, current body weight, and ideal body weight. PNI will be calculated using serum albumin and the total lymphocyte count. Height, weight, albumin, lymphocyte count, injury characteristics, associated thoracic findings, treatment requirements, hospital course, and clinical outcomes will be recorded prospectively.
The primary analysis will assess the association of GNRI and PNI with the composite short-term poor clinical outcome. The prognostic performances of the two indices will be evaluated using receiver operating characteristic curve analysis, area under the curve comparisons, and optimal cut-off values. Multivariable logistic regression analysis will be used to identify factors independently associated with the primary outcome. Hospital outcomes will be obtained from clinical records. Thirty-day emergency department revisit and mortality data will be obtained from available health records or, when necessary, by telephone follow-up.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 65 years or older.
- •Presentation to the emergency department with blunt thoracic trauma.
- •More than three rib fractures confirmed by thoracic computed tomography or another appropriate radiologic method.
- •Isolated thoracic trauma without major extra-thoracic injury.
- •Serum albumin level, total lymphocyte count, height, and weight available within the first 24 hours after presentation.
- •Written informed consent obtained from the patient or the legally authorized representative.
排除标准
- •Penetrating thoracic trauma.
- •Single rib fracture.
- •Intubation at presentation.
- •Polytrauma or major extra-thoracic injury.
- •Known advanced liver failure, nephrotic syndrome, end-stage renal disease, or hematologic disease that may substantially affect albumin or lymphocyte levels.
- •Active malignancy or cachexia related to advanced malignancy.
- •Missing data.
- •Refusal to participate in the study.
研究组 & 干预措施
Prospective Cohort of Older Adults With Multiple Rib Fractures
Adults aged 65 years or older presenting to the emergency department with isolated blunt thoracic trauma and more than three radiologically confirmed rib fractures. Participants will be followed prospectively using routinely collected clinical, laboratory, anthropometric, imaging, treatment, and follow-up data. GNRI and PNI will be calculated and their associations with short-term clinical outcomes will be evaluated. No intervention is assigned; participants receive routine clinical care.
结局指标
主要结局
Composite In-Hospital Adverse Outcome in Older Adults With Multiple Rib Fractures
时间窗: From enrollment through discharge from the index hospitalization, or up to 30 days after enrollment, whichever occurs first.
Occurrence within the index hospitalization or up to 30 days after enrollment of any of the following: in-hospital mortality; intensive care unit admission; invasive or non-invasive mechanical ventilation; pneumonia; atelectasis; chest tube placement due to pneumothorax or hemothorax; or total hospital length of stay of 7 days or longer.
次要结局
- Intensive Care Unit Admission(From enrollment through discharge from the index hospitalization or up to 30 days after enrollment, whichever occurs first.)
- Invasive or Non-invasive Mechanical Ventilation(From enrollment through discharge from the index hospitalization or up to 30 days after enrollment, whichever occurs first.)
- Pneumonia(From enrollment through discharge from the index hospitalization or up to 30 days after enrollment, whichever occurs first.)
- Atelectasis(From enrollment through discharge from the index hospitalization or up to 30 days after enrollment, whichever occurs first.)
- Tube Thoracostomy(From enrollment through discharge from the index hospitalization or up to 30 days after enrollment, whichever occurs first.)
- New-onset Pneumothorax(From enrollment through discharge from the index hospitalization or up to 30 days after enrollment, whichever occurs first.)
- New-onset Hemothorax(From enrollment through discharge from the index hospitalization or up to 30 days after enrollment, whichever occurs first.)
- Hospital Length of Stay(From hospital admission until discharge or in-hospital death, whichever occurs first, assessed up to 30 days after hospital admission.)
- 30-Day Emergency Department Revisit(From discharge from the index hospitalization through 30 days after discharge.)
- 30-Day Post-Discharge Mortality(From discharge from the index hospitalization through 30 days after discharge.)
- In-Hospital Mortality(From enrollment through 30 days after enrollment.)
研究者
Tugba Sanalp Menekse
Associate Professor of Emergency Medicine
Ankara Etlik City Hospital