Can the 5‐item Modified Frailty Index Predict Outcomes in Geriatric Trauma? A National Database Study

Abstract

Background Frailty results in increased vulnerability to adverse outcomes following trauma. We investigated the association between the 5-item modified frailty index (mFI-5) and outcomes in geriatric trauma patients. Methods The 2011-2016 Trauma Quality Improvement Program database was used to study outcomes in patients C 65 years old. The mFI-5 was measured and categorized into no frailty (mFI-5 = 0), moderate frailty (mFI-5 = 0.2), and severe frailty (mFI-5 C 0.4). Multivariable logistic regression analyses were performed to identify independent factors of mortality and complications. Results 26,963 cases met the inclusion criteria, of whom 25.5% were not frail, 38% were moderately frail, and 36.6% were severely frail. Mean age (± SD) was 76 ± 7 years, 61.5% were male, and 97.8% sustained blunt injuries. Median Injury Severity Score (ISS) was 17 (IQR = 10-26), and the median Glasgow Coma Scale was 15 (IQR = 12-15). Overall mortality was 30.6%. Factors independently associated with mortality were age (OR = 1.07 per year, 95%CI 1.06-1.07), blunt trauma (OR = 1.44, 95%CI 1.19 -1.75), ISS (OR = 1.04 per unit increase in ISS, 95%CI 1.03-1.04), and severe frailty (OR = 1.23, 95%CI 1.15-1.32). Interestingly, male sex and GCS appeared to be protective factors with OR of 0.88 (95%CI 0.83 -0.93) and 0.89 per point change in GCS (95%CI 0.88-0.9), respectively. Moderate (OR = 1.27, 95%CI 1.19-1.25) and severe frailty (OR = 1.49, 95%CI 1.-1.59) were significantly associated with in-hospital complications. Conclusion Moderate and severe frailty were significant predictors of complications. Only severe frailty was associated with short-term mortality. The mFI-5 can be used as an objective measure to stratify risks in geriatric trauma.

Gender-Based Frailty in Multiple Orthopedic Fractures

“…Although the mFI-5 has demonstrated prognostic value for post-injury outcomes, 2,3 in our study it lacked predictive value. Based on our findings, we concluded that commonly used frailty tools such as the mFI-5 are not accurate for predicting frailty-associated risks such as multiple fractures.…”

“…2 The mFI-5 has been demonstrated to provide excellent outcome data for geriatric trauma patients presenting with fractures. 2,3 However, the mFI-5 has not been used as a predictive metric to identify patients at higher risk for more severe injuries. 1 The aim of our study was to determine if the mFI-5 can be used to determine the relationship between increased frailty and multiple fractures following ground-level falls.…”

Does frailty status predict outcome in major trauma in older people? A systematic review and meta-analysis

“…We included results from 12 selected papers in the meta-analyses [ 20–31 ]. Nine studies of those were included for in-hospital mortality [ 20–23 , 25 , 26 , 29–31 ], three for LOS [ 24 , 25 , 28 ], nine for discharge to home [ 20–24 , 26 , 28 , 29 , 31 ] and eight studies for in-hospital complications [ 20–23 , 25 , 27 , 30 , 31 ].…”

“…The GRADE assessment for this result was a very low level of certainty. The level of certainty was downgraded because of a high risk of bias (four studies were at high risk of bias [ 20 , 26 , 29 , 31 ], four were moderate [ 21–23 , 30 ] and one was low [ 25 ]), potential publication bias and inconsistency (substantial heterogeneity, I 2 = 77). The inconsistency largely arose from the large Guiab et al.…”

“…Eight studies presented results that were not suitable for inclusion in the meta-analysis, seven of which were compatible with it. Six studies presented non-parametric results [ 20 , 23 , 26 , 27 , 29 ] in which the median lengths of stay in the frailty groups were significantly higher in the frail groups compared to the non-frail groups: (5 versus 4) [ 20 ], (5 versus 3) [ 23 ], (13 versus 12) [ 26 ], (12 versus 11) [ 27 ], (12 versus 11) [ 29 ] and (13 versus 12) [ 31 ]. A further study [ 18 ] provided the mean without the standard deviation, where the mean length of stay for the frail group was 18.8 days (range 1–157) compared to 18.0 days (range 1–114) for the non-frail group [ 22 ].…”