Prospective evaluation and comparison of the predictive ability of different frailty scores to predict outcomes in geriatric trauma patients

Hamidi, Mohammad; Haddadin, Zaid; Zeeshan, Muhammad; Saljuqi, Abdul Tawab; Hanna, Kamil; Tang, Andrew; Northcutt, Ashley; Kulvatunyou, Narong; Gries, Lynn; Joseph, Bellal

doi:10.1097/ta.0000000000002458

Cited by 37 publications

(33 citation statements)

References 43 publications

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“…More than 50 tools have been developed to measure frailty [ 7 ]. Several studies have shown that frailty is associated with poorer outcomes: in the emergency department, frail patients are at increased risk of death or complications for several pathologies, such as acute coronary syndrome, trauma, pneumonia, and acute cardiac failure [ 8 – 12 ]. Concerning surgery, frailty was also associated with mortality, complications, and length of stay, independent of the type of surgery [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

Fehlmann

Patel

McCallum

et al. 2021

Eur J Trauma Emerg Surg

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Purpose The purpose of this review was to determine the association between frailty and mortality among adults ≥ 65 years old undergoing emergency general surgery (EGS). Methods This systematic review followed the PRISMA guidelines (CRD42020172482 on PROSPERO). A search in MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews was conducted from inception to March 5, 2020. Studies with patients ≥ 65 years undergoing EGS were included. The primary exposure was frailty, measured using the Clinical Frailty Scale or the Modified Frailty Index. The primary outcome was 30-day mortality. Secondary outcomes were 90-day and 1-year mortality, length of stay, complications, change in level of care at discharge, and loss of independence. Two independent reviewers screened articles and extracted data. Risk of bias was assessed according to the Newcastle–Ottawa Scale and quality of evidence was assessed using the GRADE approach. A meta-analysis was performed for 30-day mortality using a random-effects model. Results Our search yielded 847 articles and six cohort studies were included in the systematic review. There were 1289 patients, 283 being frail. The pooled OR from meta-analysis for frail compared to non-frail patients was 2.91 (95% CI 2.00, 4.23) for 30-day mortality. Frailty was associated with increased odds of all secondary outcomes. Conclusion Frailty is significantly associated with worse outcomes after emergency general surgery in adults ≥ 65 years of age. The Clinical Frailty Scale could be used to improve preoperative risk assessment for patients and shared decision-making between patients and healthcare providers. Registration number CRD42020172482 (PROSPERO).

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Section: Introductionmentioning

confidence: 99%

Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

Fehlmann

Patel

McCallum

et al. 2021

Eur J Trauma Emerg Surg

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“…It takes less than 2 minutes to complete and has been validated in community-dwelling older adults to identify frail persons at risk of developing disability. 13,14 In this study, we examined the association between self-report of frailty, using an abbreviated FRAIL scale and non-home discharge (NHD), and we hypothesized that self-report of frailty as well as a positive response to individual FRAIL survey items would be associated with NHD.…”

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confidence: 99%

Association Between Patient‐Reported Frailty and Non‐Home Discharge Among Older Adults Undergoing Surgery

Sokas

Cowan

Dalton

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Identifying surgical patients at risk for discharge to a post‐acute facility has the potential to reduce hospital length of stay, improve postoperative planning, and increase patient satisfaction. We sought to examine the association between a positive response to a preoperative patient‐reported frailty screen and non‐home discharge (NHD). DESIGN Prospective cohort. SETTING Urban tertiary academic preoperative evaluation center. PARTICIPANTS Convenience sample of patients aged 60 and older evaluated from November 2018 to August 2019) undergoing one of 14 major elective general and vascular operations with an expected length of stay of 3 days or longer. METHODS Items from the previously validated Fatigue, Resistance, Ambulation, Illnesses, Loss of weight (FRAIL) screen were modified, and patients were queried on fatigue, activity against resistance, ambulation, and weight loss. Multivariable logistic regression adjusting for age and sex was used to determine the association between patient‐reported items and NHD. RESULTS A total of 230 patients were included for analysis. The average age of the cohort was 70.1 (standard deviation = 7.1); 91.7% were White, and 52.4% were female. There were 24 patients (10.4%) who were not discharged home. They were more likely to report fatigue (54% vs 29%; P = .01), weight loss (58% vs 21%; P < .01), and difficulty with activity against resistance (33% vs 7%; P < .01) before surgery. In adjusted analysis, patients who self‐reported frailty (FRAIL screen ≥2) were significantly more likely to have an NHD (odds ratio [OR] = 4.5; 95% confidence interval [CI] = 1.7–11.7; P < .01), as were patients who responded “yes” to any question from the FRAIL screen (OR = 2.5; 95% CI = 1.7–3.5; P < .01). A positive response to difficulty with activity against resistance or recent weight loss showed similar odds of NHD (OR = 7.6; 95% CI = 2.6–23.9; P < .01; and OR = 7.9; 95% CI = 2.9–21.6; P < .01, respectively). Conclusion Patient response to screening questions on the FRAIL screen identified those at highest risk of NHD. The FRAIL screening tool is practical, easy to apply, and could be used during preoperative counseling to identify patients likely to have increased discharge planning needs.

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“…However, even in patients of the same age, there is a difference in the health status, such as the degree of independent activities or underlying diseases; therefore, there will be a difference in frailty. Recent studies reported that that the degree of frailty, which is measured by an easily accessible tool for frailty is related to trauma mortality [ 18 , 19 ]. Therefore, we expect that more meaningful results would be obtained if studies are conducted to establish the definition of elderly reflecting the degree of frailty along with age.…”

Section: Discussionmentioning

confidence: 99%

The elderly age criterion for increased in-hospital mortality in trauma patients: a retrospective cohort study

Lee

Kim

Hong

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background With an aging population, the number of elderly individuals exposed to traumatic injuries is increasing. The elderly age criterion for traumatic injuries has been inconsistent in the literature. This study aimed at specifying the elderly age criterion when the traumatic mortality rate increases. Methods This is a multicenter retrospective cohort study that was conducted utilizing the data from the Emergency Department-based Injury In-depth Surveillance Registry of the Korea Disease Control and Prevention Agency, collected between January 2014 and December 2018 from 23 emergency departments. The outcome variable was in-hospital mortality. Multivariable logistic regression analysis was used to calculate the adjusted mortality rate for each age group. By using the shape-restricted regression splines method, the relationship between age and adjusted traumatic mortality was plotted and the point where the gradient of the graph had the greatest variation was calculated. Results A total of 637,491 adult trauma patients were included. The number of in-hospital deaths was 6504 (1.0%). The age at which mortality increased the most was 65.06 years old. The adjusted odds ratio for the in-hospital mortality rate with age in the ≤ 64-year-old subgroup was 1.038 (95% confidence interval (CI) 1.032–1.044) and in the ≥ 65-year-old subgroup was 1.059 (95% CI 1.050–1.068). The adjusted odds ratio for in-hospital mortality in the ≥ 65-year-old compared to the ≤ 64-year-old subgroup was 4.585 (95% CI 4.158–5.055, p < 0.001). Conclusions This study found that the in-hospital mortality rate rose with increasing age and that the increase was the most rapid from the age of 65 years. We propose to define the elderly age criterion for traumatic injuries as ≥ 65 years of age.

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Prospective evaluation and comparison of the predictive ability of different frailty scores to predict outcomes in geriatric trauma patients

Cited by 37 publications

References 43 publications

Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

Association Between Patient‐Reported Frailty and Non‐Home Discharge Among Older Adults Undergoing Surgery

The elderly age criterion for increased in-hospital mortality in trauma patients: a retrospective cohort study

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