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

Abstract

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;

Predicting Readmissions—With a Twist

“…6 In a large national database of acute hospital admissions (not only trauma admissions), falls were among the leading diagnoses for 30-day posthospital readmission, particularly among older patients with a history of cognitive impairment or acute mental status change and among those for whom the index admission involved treatment for a fall injury. 6 This is similar to the outcome reported by Hatcher et al, 5 although our study 6 had a shorter follow-up period. We now know that, for patients admitted for a fall-related injury, the leading cause-of all diagnoses-for any type of 30-day readmission is a second, distinct fall.…”

“…4 Simpler can be better: while we know that a time-consuming comprehensive battery of functional status questions can do the job, both sets of ACS guidelines promote the use of a set of just 5 questions about activities of daily living for older patients with trauma and undergoing surgery. 2,3 The article by Hatcher et al 5 adds to the literature on trauma surgery by introducing a new clinical outcome to the many already associated with prehospital functional status: readmission for a fall injury. The authors found that frailty was associated with readmission for a fall injury within the first year and the number of falls over the first year.…”

“…The authors found that frailty was associated with readmission for a fall injury within the first year and the number of falls over the first year. 5 We reported on the overall scope of the problem of hospital readmissions after fall-related injuries earlier this year. 6 In a large national database of acute hospital admissions (not only trauma admissions), falls were among the leading diagnoses for 30-day posthospital readmission, particularly among older patients with a history of cognitive impairment or acute mental status change and among those for whom the index admission involved treatment for a fall injury.…”

“…As in most large databases, however, critical information about prehospitalization functional status was not available. The results of the study by Hatcher et al 5 mean that we should gather information on prehospital function and fall history during the process of admitting older patients to the trauma service for fall injury. If done efficiently, this could even be accomplished prior to obtaining a formal physical therapy consultation (and could help prioritize physical therapy services as well).…”

“…Hence, the time to start preventing readmissions is at admission. Preventing falls in the community has always relied on multidisciplinary and often low-tech efforts; the research by Hatcher et al 5 underscores the importance of the entire medical team for gathering simple-to-acquire information on prehospital physical, cognitive, and social factors that will ease the way for patients to return safely to their homes. 7 But this might not be enough.…”