A national study of 23 major trauma centres to investigate the effect of a geriatrician assessment on clinical outcomes in older people admitted with serious injury in England (FiTR 2): a multicentre observational cohort study

Braude, Philip; Short, Roxanna; Bouamra, Omar; Shipway, David; Lecky, Fiona; Carlton, Edward; Benger, Jonathan; Gordon, Adam; Carter, Ben

doi:10.1016/s2666-7568(22)00144-1

Cited by 22 publications

(12 citation statements)

References 27 publications

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“…Early improvements in outcomes have been shown with geriatric assessment in this context. 30,31 Furthermore, these results should be used to support public health interventions around the benefit of exercise to improve recovery after injury. Exercise interventions for older people have been tested with a range of outcomes, including improvements in mental wellbeing 32 and incidence of falls.…”

Section: Discussionmentioning

confidence: 99%

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

Short

Bouamra³

et al. 2022

The Lancet Healthy Longevity

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Section: Discussionmentioning

confidence: 99%

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

Short

Bouamra³

et al. 2022

The Lancet Healthy Longevity

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“…Its aim is to provide a thorough evaluation and optimisation of older patients to improve outcomes. The complexity of CGA is demonstrated in a currently accepted definition: ‘a multidimensional diagnostic and therapeutic process that is focused on determining a frail older person’s medical, functional, mental, and social capabilities and limitations with the goal of ensuring that problems are identified, quantified and managed appropriately.’6 CGA has been demonstrated to have efficacy in medical, surgical and outpatient settings with reductions in mortality and discharge to a dependency care home up to a year of follow-up 4 6 8…”

Section: Introductionmentioning

confidence: 99%

Comprehensive geriatric assessment (CGA) in perioperative care: a systematic review of a complex intervention

et al. 2022

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ObjectivesComprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations. The aim of this systematic review was to describe how CGA is applied to surgical populations in randomised controlled trials. This will provide a basis for design of future studies focused on optimising CGA as a complex intervention.SettingA systematic review of randomised controlled trials.ParticipantsA systematic search was performed for studies of CGA in the perioperative period across Ovid MEDLINE, Ovid EMBASE, CINAHL and Cochrane CENTRAL, from inception to March 2021.InterventionsAny randomised controlled trials of perioperative CGA versus ‘standard care’ were included.Outcome measuresQualitative description of CGA.Results12 121 titles and abstracts were screened, 68 full-text articles were assessed for eligibility and 22 articles included, reporting on 13 trials. 10 trials focused on inpatients with hip fracture, with 7 of these delivering CGA on a geriatric medicine ward, 3 on a surgical ward. The remaining three trials were in elective general surgery all delivering CGA on a surgical ward. CGA components, duration of intervention and personnel delivering the intervention were highly variable across the different studies. Trials favoured postoperative delivery of CGA (11/13). Only four trials reported data on adherence to the CGA intervention.ConclusionsCGA as an intervention is variably described and delivered in randomised controlled trials in the perioperative setting. The reporting of both the intervention and standard care is often poor with little focus on adherence. Future research should focus on clearly defining and standardising the intervention as well as measuring adherence within trials.PROSPERO registration numberCRD42020221797.

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“…It is a clinical indicator that can be used to help healthcare professionals anticipate patients’ needs and proactively consider advanced care planning in discussion with the patient and their priority for specialist hospital services which can improve outcomes in older patients [ 24 ]. Other studies have found the impact of having a CFS assessment led to a reduction in mortality [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age

et al. 2022

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Background: There is no consensus on the optimal method for the assessment of frailty. We compared the prognostic utility of two approaches (modified Frailty Index [mFI], Clinical Frailty Scale [CFS]) in older adults (≥65 years) hospitalised with COVID-19 versus age. Methods: We used a test and validation cohort that enrolled participants hospitalised with COVID-19 between 27 February and 30 June 2020. Multivariable mixed-effects logistic modelling was undertaken, with 28-day mortality as the primary outcome. Nested models were compared between a base model, age and frailty assessments using likelihood ratio testing (LRT) and an area under the receiver operating curves (AUROC). Results: The primary cohort enrolled 998 participants from 13 centres. The median age was 80 (range:65–101), 453 (45%) were female, and 377 (37.8%) died within 28 days. The sample was replicated in a validation cohort of two additional centres (n = 672) with similar characteristics. In the primary cohort, both mFI and CFS were associated with mortality in the base models. There was improved precision when fitting CFS to the base model +mFI (LRT = 25.87, p < 0.001); however, there was no improvement when fitting mFI to the base model +CFS (LRT = 1.99, p = 0.16). AUROC suggested increased discrimination when fitting CFS compared to age (p = 0.02) and age +mFI (p = 0.03). In contrast, the mFI offered no improved discrimination in any comparison (p > 0.05). Similar findings were seen in the validation cohort. Conclusions: These observations suggest the CFS has superior prognostic value to mFI in predicting mortality following COVID-19. Our data do not support the use of the mFI as a tool to aid clinical decision-making and prognosis.

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A national study of 23 major trauma centres to investigate the effect of a geriatrician assessment on clinical outcomes in older people admitted with serious injury in England (FiTR 2): a multicentre observational cohort study

Cited by 22 publications

References 27 publications

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

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

Comprehensive geriatric assessment (CGA) in perioperative care: a systematic review of a complex intervention

The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age

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