Frailty score on admission predicts mortality and discharge disposition in elderly trauma patients over the age of 65 y

Curtis, Eleanor; Romanowski, Kathleen S; Sen, Soman; Hill, Ashley E.; Cocanour, Christine S.

doi:10.1016/j.jss.2018.04.017

Cited by 56 publications

(48 citation statements)

References 15 publications

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“…In our study, frailty was associated with discharge disposition to an SNF among patients with trauma-related injury, which is consistent with previous studies that used the CSHA CFS among patients with burn injuries 11 and trauma-related injuries who were older than 50 years. 3 Previous studies examining discharge disposition and mortality suggested a 66% increased risk of postdischarge mortality in patients who were not discharged to the home 14 and up to a 3-fold increase in the risk of death in the year after trauma-related injury among patients discharged to an SNF compared with those discharged to the home without assistance. 15…”

Section: Discussionmentioning

confidence: 97%

“…until sufficient data on medical comorbidities and the ability to perform activities of daily living were collected to determine preinjury frailty. 3 The CSHA CFS scores ranged from 1 to 7, with a score of 1 indicating the patient was extremely active and presented with no known comorbidities and a score of 7 indicating the patient presented with a known terminal illness and needed outside help to perform daily activities (eTable in the Supplement). Frailty was defined as a score of 5 or more.…”

Section: Methodsmentioning

confidence: 99%

“…2 Falls were the leading cause of nonfatal trauma-related injury in patients aged 65 years and older in 2015, making up 63.8% of injuries. 3 An estimated 23% to 30% of elderly individuals have experienced falls; however, less than half of them reported these incidents to their physicians. 4 Falls have been reported to often lead to a fear of falling or loss of confidence, which may result in a decline in overall activity, leading to decreased strength, balance, and mobility; cumulating in decreased functional ability and loss of independence.…”

Section: Introductionmentioning

confidence: 99%

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Association of Clinical Frailty Scores With Hospital Readmission for Falls After Index Admission for Trauma-Related Injury

et al. 2019

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IMPORTANCE Falls have been associated with morbidity and mortality in elderly patients. Assessment of frailty at hospital admission may help health care professionals evaluate fall risk in patients with trauma-related injury. OBJECTIVE To determine whether frailty assessed using the Canadian Study of Health and Aging Clinical Frailty Scale is associated with readmission for falls after index admission for trauma-related injury in patients aged 50 years and older. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study reviewed the medical records of 804 patients aged 50 years and older with trauma-related injury who were admitted to the University of Iowa Hospitals and Clinics between July 1, 2010, and June 30, 2015. Records were reviewed from May 30 to August 1, 2017, and patient demographics, admission data, injury severity scores, history of falls, and postindex readmission data for ground-level falls were recorded. Frailty scores were calculated using the Canadian Study of Health and Aging Clinical Frailty Scale. Patients with a score of 5 or higher were classified as frail. MAIN OUTCOMES AND MEASURES Frailty assessed using the Canadian Study of Health and Aging Clinical Frailty Scale and readmission for falls after index admission for trauma-related injury. RESULTS A total of 804 patients with trauma-related injury were included in the study. The mean (SD) age was 70 (13.4) years; 744 patients (93.4%) were white, and 380 (47.3%) were men. Among the total population, the mortality rate was 3.7%; 255 patients (31.7%) were classified as frail and 549 (68.3%) as nonfrail. The mean (SD) injury severity score was 9.8 (7.9), and the score was similar between frail and nonfrail patients. Of 255 frail patients, 179 (70.2%) were women, and frail patients were significantly older than nonfrail patients (mean [SD], 79.2 [12.1] years vs 66.2 [11.9] years, respectively; P < .001). The percentages of frail patients presenting to the hospital with a history of falls and readmitted for falls after index admission were higher than those of nonfrail patients (63 [24.8%] vs 53 [9.6%] and 55 [21.6%] vs 58 [10.6%], respectively; both P < .001). Frailty was associated with discharge to the home with health care (odds ratio [OR], 4.82; 95% CI, 2.10-11.01;

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Clinical Frailty Scores With Hospital Readmission for Falls After Index Admission for Trauma-Related Injury

et al. 2019

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“…30,31 The "frailty index" has been shown to be an independent predictor of poor health outcomes, in-hospital complications, and adverse discharge disposition among older trauma patients. [32][33][34] Hitherto, no frailty assessment tool has been used for older trauma patients as a method of prehospital triage.…”

Section: Frailty Assessment In Prehospital Carementioning

confidence: 99%

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

Alshibani¹,

Banerjee²,

Lecky³

et al. 2021

OAEM

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Caring for older people is an important part of prehospital practice, including appropriate triage and transportation decisions. However, prehospital triage criteria are designed to predominantly assess injury severity or high-energy mechanism which is not the case for older people who often have injuries compounded by multimorbidity and frailty. This has led to high rates of under-triage in this population. This narrative review aimed to assess aspects other than triage criteria to better understand and improve prehospital triage decisions for older trauma patients. This includes integrating frailty assessment in prehospital trauma triage, which was shown to predict adverse outcomes for older trauma patients. Furthermore, determining appropriate outcome measures and the benefits of Major Trauma Centers (MTCs) for older trauma patients should be considered in order to direct accurate and more beneficial prehospital trauma triage decisions. It is still not clear what are the appropriate outcome measures that should be applied when caring for older trauma patients. There is also no strong consensus about the benefits of MTC access for older trauma patients with regards to survival, in-hospital length of stay, discharge disposition, and complications. Moreover, looking into factors other than triage criteria such as distance to MTCs, patient or relative choice, training, unfamiliarity with protocols, and possible ageism, which were shown to impact prehospital triage decisions but their impact on outcomes has not been investigated yet, should be more actively assessed and investigated for this population. Therefore, this paper aimed to discuss the available evidence around frailty assessment in prehospital care, appropriate outcome measures for older trauma patients, the benefits of MTC access for older patients, and factors other than triage criteria that could adversely impact accurate prehospital triage decisions for older trauma patients. It also provided several suggestions for the future.

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“…1,2 Fall-related injury represents a significant portion of traumatic injury in the elderly, and this population is particularly vulnerable to repeat fall episodes. [3][4][5] Each year, up to 30% of the elderly population experiences at least one or more falls. The morbidity following a fall-related traumatic injury can exacerbate fears of repeat fall episodes that reduce activity and further perpetuates increased debilitation.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Comparison of Frailty Scores and Fall Prediction in Acutely Injured Older Adults

Tejiram

Cartwright

Taylor

et al. 2021

Journal of Surgical Research

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Background: Elderly (65 and older) fall-related injuries are a significant cause of morbidity and mortality. Although frailty predicts poor outcomes in geriatric trauma, literature comparing frailty scoring systems remains limited. Herein, we evaluated which frailty scoring system best predicts falls over time in the elderly. Materials and methods: Acute surgical patients 65 y and older were enrolled and prospectively observed. Demographics and frailty, assessed using the FRAIL Scale, Trauma Specific Frailty Index (TSFI), and Canadian Frailty Scale (CSHA-CFS), were collected at enrollment and 3 mo intervals following discharge for 1 y. Surveys queried the total number and timing of falls. Changes in frailty over time were assessed by logistic regression and area under the curve (AUC). Results: Fifty-eight patients were enrolled. FRAIL Scale and CSHA-CFS scores did not change over time, but TSFI scores did (P 0.01). Worsening frailty was observed using TSFI at 6 (P 0.01) and 12 mo (P 0.01) relative to baseline. Mortality did not differ based on frailty using any frailty score. Increasing frailty scores and time postdischarge was associated with increased odds of a fall. AUC estimates with 95% CI were 0.72 [0.64, 0.80], 0.81 [0.74, 0.88], and 0.76 [0.68, 0.84] for the FRAIL Scale, TSFI, and CSHA-CFS, respectively. Conclusions: The risk of falls postdischarge were associated with increased age, time postdischarge, and frailty in our population. No scale appeared to significantly outperform the other by AUC estimation. Further study on the longitudinal effects of frailty is warranted.

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Frailty score on admission predicts mortality and discharge disposition in elderly trauma patients over the age of 65 y

Cited by 56 publications

References 15 publications

Association of Clinical Frailty Scores With Hospital Readmission for Falls After Index Admission for Trauma-Related Injury

Association of Clinical Frailty Scores With Hospital Readmission for Falls After Index Admission for Trauma-Related Injury

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

A Prospective Comparison of Frailty Scores and Fall Prediction in Acutely Injured Older Adults

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