The Frailty Index appears to predict in-hospital complications and discharge disposition in geriatric trauma patients, a new study found.
Researchers performed a prospective cohort study at a level 1 trauma center to determine whether the Frailty Index (FI) was a useful assessment tool for predicting outcomes in geriatric trauma patients in addition to geriatric patients overall. Frailty was prospectively measured in all trauma patients who were geriatric, defined as at least 65 years of age. Fifty preadmission variables were used to calculate the FI, and patients who had an FI of 0.25 or greater were classified as frail. The study's primary and secondary outcome measures were in-hospital complications and adverse discharge disposition (defined as in-hospital death or discharge to a skilled nursing facility), respectively. The study results were published online June 11 by JAMA Surgery.
A total of 250 patients were included in the study. Their mean age was 77.9 years, their median Injury Severity Score was 15 (range, 9 to 18), and their median Glasgow Coma Scale score was 15 (range, 12 to 15). Most patients (69.2%) were men. Mean FI was 0.21, and 110 patients (44%) were classified as frail. At presentation, frail and nonfrail patients did not differ in age, mechanism of injury, systolic blood pressure, or Glasgow Coma Scale score. Frail patients were more likely than nonfrail patients to have complications while hospitalized (37.3% vs. 21.4%; odds ratio, 2.5; P=0.001) and to have adverse discharge disposition (37.3% vs. 12.9%; odds ratio, 1.6; P=0.001). Urinary tract infections and pneumonia were the most common in-hospital complications in the frail group, occurring in 12 and 10 patients, respectively. Five patients (2%) died, all of whom were classified as frail.
The researchers noted that they evaluated patients at only one academic medical center and didn't examine how frailty affected long-term functional outcomes or quality of life. However, they stressed that “Early assessment and identification of vulnerable patients is critical in optimizing outcomes in geriatric trauma patients” and concluded that FI independently predicts in-hospital complications and adverse discharge disposition in this group. “The FI should be used as a clinical tool for risk stratification across trauma centers to standardize geriatric trauma patient management,” they concluded.
The authors of an accompanying invited commentary noted that a frailty score could affect care of trauma patients by allowing implementation of evidence-based pathways such as Acute Care for the Elderly (ACE) and by informing clinical decisions about safe discharge after falling from a standing height. “Although the best frailty tool for trauma cases has yet to be determined, this study should trigger further research and quality improvement efforts targeting the growing population of trauma patients with frailty,” the commentary authors wrote.