Clinical frailty score: A useful tool in predicting outcomes in patients with fragility fractures

Abstract

Introduction Frailty is a known risk factor for falls and subsequent fractures and is linked to greater hospitalisation, morbidity, and mortality in various areas of medicine. A 2017 Trauma Audit and Research Network (TARN) report identified that further research was needed to determine the effect of frailty on outcomes in trauma patients. The UK Best Practice Tariff currently awards a financial incentive for frailty scoring for all patients sustaining major trauma who are managed at Major Trauma Centres (MTCs). However, this currently does not extend to Trauma Units (TUs) or to patients without major trauma. This retrospective cohort study sought to investigate whether frailty also has a significant effect on outcomes in patients presenting with fragility fractures presenting to trauma units without major trauma. Methods Notes from all patients aged ≥65 admitted to Gloucestershire Royal Hospital in 2019 with any fragility fracture were reviewed retrospectively. Age, injury, length of stay, and mortality were recorded. A Clinical Frailty Score (CFS) was assigned retrospectively using the Rockwood Clinical Frailty Scale. Results Eight hundred sixty patients were reviewed (male:female 258:602, mean age 83 ± 8.2). Each consecutive stepwise increase in CFS was independently associated with an average cumulative increase in mortality rate at 30-day and 1 year (OR 1.55 and 1.58 respectively, p < 0.001), as well as average cumulative percentage increase in length of stay (OR 1.094, p < 0.001). Conclusion Clinical frailty score independently predicts adverse outcome in patients with fragility fractures managed at trauma units. Clinical frailty score could be used to easily identify patients at risk of poorer outcomes and may assist in allocation of limited orthogeriatric resources and future BPT guidelines. Further work should promote recognition of frailty within trauma settings, investigate how additional resources affect outcomes for patients of varying degrees of frailty, and consider multicentre studies relating to frailty-associated outcomes in trauma.

Exercise to Prevent and Manage Frailty and Fragility Fractures

“…Frailty is also a known risk factor for fragility fractures. A recent study of hospitalised patients (n = 866) identified that for every stepwise increase in the CFS score, the likelihood of mortality increased [OR values of 1.55 and 1.88 for 30-day and 1-year mortality respectively] [15]. Collectively, these findings highlight that approaches to prevent and manage frailty should also incorporate strategies targeting osteoporosis, sarcopenia, and fragility fractures.…”

“…Frailty is associated with a decline of musculoskeletal, sensory, and neurological systems, which in turn increases falls risk [12,13], likelihood of hip fracture [12,13], and low trauma fragility fractures [5]. In the clinical setting, frailty can predict response to treatment and the likelihood of adverse clinical outcomes, and thus can be used to quantify any likely harms or benefits from proposed medical or surgical interventions [14,15]. For instance, individuals with fragility fractures can be assessed for frailty in acute care and this information may be used to guide patient care planning.…”