The impact of frailty in major trauma in older patients

Pecheva, M; Phillips, Mark Salber; Hull, Peter; A, O'Leary R Carrothers; Queally, JM

doi:10.1016/j.injury.2020.04.045

Cited by 47 publications

(34 citation statements)

References 23 publications

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“…Frailty is known to be an independent predictor of mortality, morbidity, and hospitalizations among older adults from studies including older trauma patients. 30,31 The "frailty index" has been shown to be an independent predictor of poor health outcomes, in-hospital complications, and adverse discharge disposition among older trauma patients. [32][33][34] Hitherto, no frailty assessment tool has been used for older trauma patients as a method of prehospital triage.…”

Section: Frailty Assessment In Prehospital Carementioning

confidence: 99%

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

Alshibani¹,

Banerjee²,

Lecky³

et al. 2021

OAEM

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Caring for older people is an important part of prehospital practice, including appropriate triage and transportation decisions. However, prehospital triage criteria are designed to predominantly assess injury severity or high-energy mechanism which is not the case for older people who often have injuries compounded by multimorbidity and frailty. This has led to high rates of under-triage in this population. This narrative review aimed to assess aspects other than triage criteria to better understand and improve prehospital triage decisions for older trauma patients. This includes integrating frailty assessment in prehospital trauma triage, which was shown to predict adverse outcomes for older trauma patients. Furthermore, determining appropriate outcome measures and the benefits of Major Trauma Centers (MTCs) for older trauma patients should be considered in order to direct accurate and more beneficial prehospital trauma triage decisions. It is still not clear what are the appropriate outcome measures that should be applied when caring for older trauma patients. There is also no strong consensus about the benefits of MTC access for older trauma patients with regards to survival, in-hospital length of stay, discharge disposition, and complications. Moreover, looking into factors other than triage criteria such as distance to MTCs, patient or relative choice, training, unfamiliarity with protocols, and possible ageism, which were shown to impact prehospital triage decisions but their impact on outcomes has not been investigated yet, should be more actively assessed and investigated for this population. Therefore, this paper aimed to discuss the available evidence around frailty assessment in prehospital care, appropriate outcome measures for older trauma patients, the benefits of MTC access for older patients, and factors other than triage criteria that could adversely impact accurate prehospital triage decisions for older trauma patients. It also provided several suggestions for the future.

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Section: Frailty Assessment In Prehospital Carementioning

confidence: 99%

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

Alshibani¹,

Banerjee²,

Lecky³

et al. 2021

OAEM

View full text Add to dashboard Cite

show abstract

“…The assessment of 'frailty' could also help in determining the severity of injury for these patients. It was shown to be an independent predictor of adverse outcomes for older trauma patients [32,35].…”

Section: Recommendations For Practice and Future Researchmentioning

confidence: 98%

Towards improving prehospital triage for older trauma patients

2021

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Background:The proportions of older adults with major trauma is increasing. Highquality care for this population requires accurate and effective prehospital trauma triage decisions.Objectives: Anatomicalal and physiologicalal changes with age, comorbidities, and medications use for older adults may affect the accuracy of prehospital trauma triage. Materials and methods:This narrative review focuses on age-related anatomicalal and physiologicalal changes, comorbidities, and medications use for older adults with an emphasis on their impact on the accuracy of prehospital trauma triage tools. It also addresses efforts to develop alternative triage criteria to reduce under-triage.Results: These factors were shown to affect physiological responses to injury and mechanism of injury for older people. Current triage tools poorly predicted injury severity. Geriatric-specific physiologicalal measures and comorbidities significantly improved sensitivity with much lower specificity. Assessing anticoagulant or antiplatelet use in head injury notably improved sensitivity to identify traumatic intracranial haemorrhage, neurosurgery or death with modest decrease in specificity.Conclusions: Improving paramedics' knowledge about the challenges when assessing older people with silver trauma may reduce under-triage. Assessing frailty could help in predict injury severity. Future research is needed to improve triage decisions for this population.

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“…One study has been published since the search date of these reviews, which examined the effect of the modified frailty index (mFI) on 1‐year mortality. It showed modest impact on 1‐year mortality associated with only the most severe level of frailty 9 …”

Section: Introductionmentioning

confidence: 99%

Predicting 1 year mortality after traumatic injury using the Clinical Frailty Scale

Braude

Carter

Parry

et al. 2021

J American Geriatrics Society

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Background: Frailty is known to affect how people admitted with traumatic injuries recover during their inpatient stay and shortly after discharge. However, few studies have examined the effect of frailty on long-term mortality when adjusted for significant factors including age. We aimed to determine the effect of frailty on 1-year morality in older adults admitted with traumatic injuries. Methods: We undertook an observational study at the Severn Major Trauma Network's major trauma centre based in South West England. Patients ≥65 years old admitted between November 2018 and September 2019 with traumatic injuries were included. Isolated hip fractures and inpatient injuries were excluded. A geriatrician assessed all patients for frailty using the Clinical Frailty Scale. Follow-up occurred at 1 year. A multivariable Cox proportional baseline hazards model assessed the effect of frailty on time-to-mortality. The adjusted model included age, sex, multimorbidity, surgery, most injured site, injury severity, postinjury complications, and geriatrician review. Results: Five hundred and eighty-five patients were included. Median age was 81 years old (IQR 74-88), and median injury severity score was 13 (IQR 9-25).At 1 year 147 (25.1%) patients had died. Living with frailty was associated with mortality. The risk of dying increased with frailty severity. Compared to CFS 1-3: CFS 4 aHR = 1.73 (95% CI 0.89-3.36, p = 0.11); CFS 5 aHR = 3.82 (95% CI 2.11-6.93, p < 0.001); CFS 6 aHR = 4Á05 (95% CI 2.21-7.45, p < 0.001); CFS 7-8 aHR = 6.57 (95% CI 3.43-12.59, p < 0.001). Conclusion:This study is the first to demonstrate a consistent effect of frailty, at all levels of severity and independent of age, on older peoples' survival 1 year after traumatic injury. These data support performing an admission frailty assessment to aid long-term management decisions and provide opportunity to modify frailty to improve outcomes.

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The impact of frailty in major trauma in older patients

Cited by 47 publications

References 23 publications

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

Towards improving prehospital triage for older trauma patients

Predicting 1 year mortality after traumatic injury using the Clinical Frailty Scale

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