TY - JOUR
T1 - It is not all black and white
T2 - The effect of increasing severity of frailty on outcomes of geriatric trauma patients
AU - Alizai, Qaidar
AU - Colosimo, Christina
AU - Hosseinpour, Hamidreza
AU - Stewart, Collin
AU - Bhogadi, Sai Krishna
AU - Nelson, Adam
AU - Spencer, Audrey L.
AU - Ditillo, Michael
AU - Magnotti, Louis J.
AU - Joseph, Bellal
AU - Amos, Joseph D.
AU - Teichman, Amanda
AU - Whitmill, Melissa L.
AU - Burruss, Sigrid K.
AU - Dunn, Julie A.
AU - Najafi, Kaveh
AU - Godat, Laura N.
AU - Enniss, Toby M.
AU - Shoultz, Thomas H.
AU - Egodage, Tanya
AU - Bongiovanni, Tasce
AU - Hazelton, Joshua P.
AU - Colling, Kristin P.
AU - Costantini, Todd W.
AU - Stein, Deborah M.
AU - Schroeppel, Thomas J.
AU - Nahmias, Jeffry
AU - El-Qawaqzeh, Khaled
AU - Choron, Rachel L.
AU - Comish, Paul B.
AU - Leneweaver, Kyle
AU - Palmer, Brandi
AU - Truitt, Michael S.
AU - Farrell, Mike
AU - Laufenberg, Lacee J.
AU - Lasso-Tay, Erica
AU - Stillman, Zachery
AU - Hass, Daniel T.
AU - Grossman, Heather M.
AU - Gordon, Darnell
AU - Krause, Cassandra
AU - Thomas, Jonathan
N1 - Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - BACKGROUND Frailty is associated with poor outcomes in trauma patients. However, the spectrum of physiologic deficits, once a patient is identified as frail, is unknown. The aim of this study was to assess the dynamic association between increasing frailty and outcomes among frail geriatric trauma patients. METHODS This is a secondary analysis of the American Association of Surgery for Trauma Frailty Multi-institutional Trial. Patients 65 years or older presenting to one of the 17 trauma centers over 3 years (2019-2022) were included. Frailty was assessed within 24 hours of presentation using the Trauma-Specific Frailty Index (TSFI) questionnaire. Patients were stratified by TSFI score into six groups: nonfrail (<0.12), Grade I (0.12-0.19), Grade II (0.20-0.29), Grade III (0.30-0.39), Grade IV (0.40-0.49), and Grade V (0.50-1). Our Outcomes included in-hospital and 3-month postdischarge mortality, major complications, readmissions, and fall recurrence. Multivariable regression analyses were performed. RESULTS There were 1,321 patients identified. The mean (SD) age was 77 years (8.6 years) and 49% were males. Median [interquartile range] Injury Severity Score was 9 [5-13] and 69% presented after a low-level fall. Overall, 14% developed major complications and 5% died during the index admission. Among survivors, 1,116 patients had a complete follow-up, 16% were readmitted within 3 months, 6% had a fall recurrence, 7% had a complication, and 2% died within 3 months postdischarge. On multivariable regression, every 0.1 increase in the TSFI score was independently associated with higher odds of index-admission mortality and major complications, and 3 months postdischarge mortality, readmissions, major complications, and fall recurrence. CONCLUSION The frailty syndrome goes beyond a binary stratification of patients into nonfrail and frail and should be considered as a spectrum of increasing vulnerability to poor outcomes. Frailty scoring can be used in developing guidelines, patient management, prognostication, and care discussions with patients and their families. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
AB - BACKGROUND Frailty is associated with poor outcomes in trauma patients. However, the spectrum of physiologic deficits, once a patient is identified as frail, is unknown. The aim of this study was to assess the dynamic association between increasing frailty and outcomes among frail geriatric trauma patients. METHODS This is a secondary analysis of the American Association of Surgery for Trauma Frailty Multi-institutional Trial. Patients 65 years or older presenting to one of the 17 trauma centers over 3 years (2019-2022) were included. Frailty was assessed within 24 hours of presentation using the Trauma-Specific Frailty Index (TSFI) questionnaire. Patients were stratified by TSFI score into six groups: nonfrail (<0.12), Grade I (0.12-0.19), Grade II (0.20-0.29), Grade III (0.30-0.39), Grade IV (0.40-0.49), and Grade V (0.50-1). Our Outcomes included in-hospital and 3-month postdischarge mortality, major complications, readmissions, and fall recurrence. Multivariable regression analyses were performed. RESULTS There were 1,321 patients identified. The mean (SD) age was 77 years (8.6 years) and 49% were males. Median [interquartile range] Injury Severity Score was 9 [5-13] and 69% presented after a low-level fall. Overall, 14% developed major complications and 5% died during the index admission. Among survivors, 1,116 patients had a complete follow-up, 16% were readmitted within 3 months, 6% had a fall recurrence, 7% had a complication, and 2% died within 3 months postdischarge. On multivariable regression, every 0.1 increase in the TSFI score was independently associated with higher odds of index-admission mortality and major complications, and 3 months postdischarge mortality, readmissions, major complications, and fall recurrence. CONCLUSION The frailty syndrome goes beyond a binary stratification of patients into nonfrail and frail and should be considered as a spectrum of increasing vulnerability to poor outcomes. Frailty scoring can be used in developing guidelines, patient management, prognostication, and care discussions with patients and their families. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
KW - Frailty
KW - frailty index
KW - frailty spectrum
KW - geriatric trauma
KW - trauma outcomes
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U2 - 10.1097/TA.0000000000004217
DO - 10.1097/TA.0000000000004217
M3 - Article
C2 - 37994092
AN - SCOPUS:85185702299
SN - 2163-0755
VL - 96
SP - 434
EP - 442
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 3
ER -