It Is Not All Black and White: The Effect of Increasing Severity of Frailty on Outcomes of Geriatric Trauma Patients

Authors

Qaidar Alizai, University of Arizona School of Medicine
Christina Colosimo, University of Arizona School of Medicine
Hamidreza Hosseinpour, University of Arizona School of Medicine
Collin Stewart, University of Arizona School of Medicine
Sai Krishna Bhogadi, University of Arizona School of Medicine
Adam Nelson, University of Arizona School of Medicine
Audrey L. Spencer, University of Arizona School of Medicine
Michael Ditillo, University of Arizona School of Medicine
Louis J. Magnotti, University of Arizona School of Medicine
Bellal Joseph, University of Arizona School of Medicine
AAST Frailty MIT Study Group

Document Type

Article

Publication Date

3-1-2024

Identifier/URL

40945606 (Pure); 37994092 (PubMed)

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Abstract

Background: Frailty is associated with poor outcomes in trauma patients. However, the spectrum of physiologic deficits, once a patient is identified as frail, is unknown. The aim of this study was to assess the dynamic association between increasing frailty and outcomes among frail geriatric trauma patients. Methods: This is a secondary analysis of the American Association of Surgery for Trauma Frailty Multi-institutional Trial. Patients 65 years or older presenting to one of the 17 trauma centers over 3 years (2019-2022) were included. Frailty was assessed within 24 hours of presentation using the Trauma-Specific Frailty Index (TSFI) questionnaire. Patients were stratified by TSFI score into six groups: nonfrail (<0.12), Grade I (0.12-0.19), Grade II (0.20-0.29), Grade III (0.30-0.39), Grade IV (0.40-0.49), and Grade V (0.50-1). Our Outcomes included in-hospital and 3-month postdischarge mortality, major complications, readmissions, and fall recurrence. Multivariable regression analyses were performed. Results: There were 1,321 patients identified. The mean (SD) age was 77 years (8.6 years) and 49% were males. Median [interquartile range] Injury Severity Score was 9 [5-13] and 69% presented after a low-level fall. Overall, 14% developed major complications and 5% died during the index admission. Among survivors, 1,116 patients had a complete follow-up, 16% were readmitted within 3 months, 6% had a fall recurrence, 7% had a complication, and 2% died within 3 months postdischarge. On multivariable regression, every 0.1 increase in the TSFI score was independently associated with higher odds of index-admission mortality and major complications, and 3 months postdischarge mortality, readmissions, major complications, and fall recurrence. Conclusion: The frailty syndrome goes beyond a binary stratification of patients into nonfrail and frail and should be considered as a spectrum of increasing vulnerability to poor outcomes. Frailty scoring can be used in developing guidelines, patient management, prognostication, and care discussions with patients and their families.

Comments

Publisher Copyright: © Wolters Kluwer Health, Inc. All rights reserved.

Repository Citation

Alizai, Q., Colosimo, C., Hosseinpour, H., Stewart, C., Bhogadi, S. K., Nelson, A., Spencer, A. L., Ditillo, M., Magnotti, L. J., Joseph, B., & (2024). It Is Not All Black and White: The Effect of Increasing Severity of Frailty on Outcomes of Geriatric Trauma Patients. Journal of Trauma and Acute Care Surgery, 96 (3), 434-442.
https://corescholar.libraries.wright.edu/surg/849

DOI

10.1097/TA.0000000000004217