Predicting the time of mortality among older adult trauma patients: Is frailty the answer?

Introduction: This study aims to evaluate the temporal trends of mortality among frail versus non-frail older adult trauma patients during index hospitalization. Methods: We performed a 3-year (2017–2019) analysis of ACS-TQIP. We included all older adult (age ≥65 years) trauma patients. Patients were stratified into two groups (Frail vs. Non-Frail). Outcomes were acute (<24 ​h), early (24–72 ​h), intermediate (72 hours-1 week), and late (>1 week) mortality. Results: A total of 1,022,925 older adult trauma patients were identified, of which 19.7 ​% were frail. The mean(SD) age was 77(8) years and 57.4 ​% were female. Median[IQR] ISS was 9[4–10] and both groups had comparable injury severity (p ​= ​0.362). On multivariable analysis, frailty was not associated with acute (aOR 1.034; p ​= ​0.518) and early (aOR 1.190; p ​= ​0.392) mortality, while frail patients had independently higher odds of intermediate (aOR 1.269; p ​= ​0.042) and late (aOR 1.835; p ​< ​0.001) mortality. On sub-analysis, our results remained consistent in mild, moderate, and severely injured patients. Conclusion: Frailty is an independent predictor of mortality in older adult trauma patients who survive the initial 3 days of admission, regardless of injury severity.