A national study of 23 major trauma centres to investigate the effect of frailty on clinical outcomes in older people admitted with serious injury in England (FiTR 1): a multicentre observational study

Carter, Ben; Short, Roxanna; Bouamra, Omar; Parry, Frances; Shipway, David; Thompson, Julian; Baxter, Mark; Lecky, Fiona; Braude, Philip

doi:10.1016/s2666-7568(22)00122-2

Cited by 21 publications

(14 citation statements)

References 33 publications

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“…The association between frailty and adverse outcomes in geriatric trauma patients has been previously demonstrated. 17,25 By demonstrating that frailty independently contributes to an increased risk of FTR, this study's findings underscore the need to incorporate frailty assessment into the evaluation and management of geriatric trauma patients. The observed linear relationship between mFI scores and the incidence of FTR indicates that even small increases in frailty may significantly impact outcomes.…”

Section: Discussionmentioning

confidence: 77%

Does Frailty Impact Failure-to-Rescue in Geriatric Trauma Patients?

Kojima,

Morishita,

Shoko

et al. 2024

J Trauma Acute Care Surg

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Background Failure-to-rescue (FTR), defined as death following a major complication, is a metric of trauma quality. The impact of patient frailty on FTR has not been fully investigated, especially in geriatric trauma patients. This study hypothesized that frailty increased the risk of FTR in geriatric patients with severe injury. Methods A retrospective cohort study was conducted using the TQIP database between 2015 and 2019, including geriatric patients with trauma (age ≥ 65 years) and an Injury Severity Score (ISS) > 15, who survived ≥48 h post-admission. Frailty was assessed using the modified 5-item frailty index (mFI). Patients were categorized into frail (mFI ≥ 2) and non-frail (mFI < 2) groups. Logistic regression analysis and a generalized additive model (GAM) were used to examine the association between FTR and patient frailty after controlling for age, sex, type of injury, trauma center level, ISS, and vital signs on admission. Results Among 52,312 geriatric trauma patients, 34.6% were frail (mean mFI: frail: 2.3 vs. non-frail: 0.9, p < 0.001). Frail patients were older (age 77 vs. 74 years, p < 0.001), had a lower ISS (19 vs. 21, p < 0.001), and had a higher incidence of FTR compared to non-frail patients (8.7% vs. 8.0%, p = 0.006). Logistic regression analysis revealed that frailty was an independent predictor of FTR (odds ratio [CI]: 1.32 [1.23-1.44], p < 0.001). The GAM plots showed a linear increase in FTR incidence with increasing mFI after adjusting for confounders. Conclusion This study demonstrated that frailty independently contributes to an increased risk of FTR in geriatric trauma patients. The impact of patient frailty should be considered when using FTR to measure the quality of trauma care. Level of Evidence Level IV, therapeutic/care management

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Section: Discussionmentioning

confidence: 77%

Does Frailty Impact Failure-to-Rescue in Geriatric Trauma Patients?

Kojima,

Morishita,

Shoko

et al. 2024

J Trauma Acute Care Surg

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“…The analysis will be adjusted for factors previously shown to be associated with mortality in this population, 1,3 including: age group, gender, time-period, ISS, major post-injury complications, most severely injured body part, if underwent surgery (Y/N). Both crude hazard ratio (HR) and adjusted hazard ratio (aHR) will be estimated with associated 95% confidence intervals (CI).…”

Section: Discussionmentioning

confidence: 99%

“…Not applicable 1 Background Around half of United Kingdom (UK) major trauma admissions are adults aged 65 years or older. 2,3 In this population many patients are living with frailty. 4 Since 2019, frailty assessment has been a mandated part of clinical assessment in older adults admitted with major trauma, when it became part of the best practice tariff (BPT).…”

Section: Financial and Non-financialmentioning

confidence: 99%

A long-term prospective cohort study of seriously injured older trauma patients

Ibitoye

Bridgeman-Rutledge

Carter

et al. 2022

Preprint

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A protocol for a prospective observational cohort study to investigate the effect of frailty on long-term outcomes in older adults admitted with trauma. Patients aged 65 years and older admitted to the Severn Major Trauma Centre at North Bristol NHS Trust in England between November 2018 and September 2019, will be followed up at 4-years. The objective is to determine if there is an association between Clinical Frailty Scale and mortality at 4 years after admission to hospital with a traumatic injury. The primary outcome will be mortality as measured by time from hospital admission to death. Analyses will be adjusted for other factors shown to be associated with mortality, using a mixed-effects multivariable Cox proportional hazards model.

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“…Future work should include large-scale studies, at a patient or site level, to understand the effect of a geriatrician review at different severities of frailty. 28 Such work should investigate the mechanisms by which a patient is either referred to, or identified by, a geriatrician, and the timing and components of the assessment.…”

Section: Mechanism Of Injurymentioning

confidence: 99%