Redefining the association between old age and poor outcomes after trauma: The impact of frailty syndrome

Bellal A Joseph, Tahereh Orouji Jokar, Ahmed Hassan, Asad Azim, Martha J Mohler, Narong Kulvatunyou, Shirin Siddiqi, Herb Phelan, Mindy J Fain, Peter M Rhee

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Frailty syndrome (FS) is a well-established predictor of outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and to determine its association with trauma readmissions, repeat falls, and mortality at 6 months. Methods: we performed a 2-year (2012-2013) prospective cohort analysis of all consecutive geriatric (age, ≥ 65 years) trauma patients. FS was assessed using a Trauma-Specific Frailty Index (TSFI). Patients were stratified into: nonfrail, TSFI ≤ 0.12; prefrail, TSFI = 0.1 to 0.27; and frail, TSFI > 0.27. Patient follow-up occurred at 6 months to assess outcomes. Regression analysis was performed to assess independent associations between TSFI and outcomes. Results: Three hundred fifty patients were enrolled. Frail patients were more likely to develop in-hospital complications (nonfrail, 12%; prefrail, 17.4%; and frail, 33.4%; p = 0.02) and an adverse discharge disposition compared with nonfrail and prefrail (nonfrail, 8%; prefrail,18%; and frail, 47%; p = 0.001). Six-month follow-up was recorded in 80% of the patients. Compared with nonfrail patients, frail patients were more likely to have had a trauma-related readmission (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-3.6) and/or repeated falls (OR, 1.6; 95%CI, 1.1-2.5) over the 6-month period. Overall 6-month mortality was 2.8% (n = 10), and frail elderly patients were more likely to have died (OR, 1.1; 95% CI, 1.04-4.7) compared with nonfrail patients. Conclusion: Over a third of geriatric trauma patients had FS. TSFI provides a practical and accurate assessment tool for identifying elderly trauma patients who are at increased risk of both short-term and long-term outcomes. Early focused intervention in frail geriatric patients is warranted to improve long-term outcomes. Level of Evidence: Prognostic study, level II.

Original languageEnglish (US)
Pages (from-to)575-581
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume82
Issue number3
DOIs
StatePublished - Mar 1 2017

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Wounds and Injuries
Geriatrics
Odds Ratio
Confidence Intervals
Frail Elderly
Mortality
Cohort Studies
Regression Analysis

Keywords

  • falls
  • frailty
  • Geriatrics
  • long-term outcomes
  • mortality
  • readmissions

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Redefining the association between old age and poor outcomes after trauma : The impact of frailty syndrome. / Joseph, Bellal A; Orouji Jokar, Tahereh; Hassan, Ahmed; Azim, Asad; Mohler, Martha J; Kulvatunyou, Narong; Siddiqi, Shirin; Phelan, Herb; Fain, Mindy J; Rhee, Peter M.

In: Journal of Trauma and Acute Care Surgery, Vol. 82, No. 3, 01.03.2017, p. 575-581.

Research output: Contribution to journalArticle

Joseph, Bellal A ; Orouji Jokar, Tahereh ; Hassan, Ahmed ; Azim, Asad ; Mohler, Martha J ; Kulvatunyou, Narong ; Siddiqi, Shirin ; Phelan, Herb ; Fain, Mindy J ; Rhee, Peter M. / Redefining the association between old age and poor outcomes after trauma : The impact of frailty syndrome. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 82, No. 3. pp. 575-581.
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abstract = "Background: Frailty syndrome (FS) is a well-established predictor of outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and to determine its association with trauma readmissions, repeat falls, and mortality at 6 months. Methods: we performed a 2-year (2012-2013) prospective cohort analysis of all consecutive geriatric (age, ≥ 65 years) trauma patients. FS was assessed using a Trauma-Specific Frailty Index (TSFI). Patients were stratified into: nonfrail, TSFI ≤ 0.12; prefrail, TSFI = 0.1 to 0.27; and frail, TSFI > 0.27. Patient follow-up occurred at 6 months to assess outcomes. Regression analysis was performed to assess independent associations between TSFI and outcomes. Results: Three hundred fifty patients were enrolled. Frail patients were more likely to develop in-hospital complications (nonfrail, 12{\%}; prefrail, 17.4{\%}; and frail, 33.4{\%}; p = 0.02) and an adverse discharge disposition compared with nonfrail and prefrail (nonfrail, 8{\%}; prefrail,18{\%}; and frail, 47{\%}; p = 0.001). Six-month follow-up was recorded in 80{\%} of the patients. Compared with nonfrail patients, frail patients were more likely to have had a trauma-related readmission (odds ratio [OR], 1.4; 95{\%} confidence interval [CI], 1.2-3.6) and/or repeated falls (OR, 1.6; 95{\%}CI, 1.1-2.5) over the 6-month period. Overall 6-month mortality was 2.8{\%} (n = 10), and frail elderly patients were more likely to have died (OR, 1.1; 95{\%} CI, 1.04-4.7) compared with nonfrail patients. Conclusion: Over a third of geriatric trauma patients had FS. TSFI provides a practical and accurate assessment tool for identifying elderly trauma patients who are at increased risk of both short-term and long-term outcomes. Early focused intervention in frail geriatric patients is warranted to improve long-term outcomes. Level of Evidence: Prognostic study, level II.",
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T2 - The impact of frailty syndrome

AU - Joseph, Bellal A

AU - Orouji Jokar, Tahereh

AU - Hassan, Ahmed

AU - Azim, Asad

AU - Mohler, Martha J

AU - Kulvatunyou, Narong

AU - Siddiqi, Shirin

AU - Phelan, Herb

AU - Fain, Mindy J

AU - Rhee, Peter M

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N2 - Background: Frailty syndrome (FS) is a well-established predictor of outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and to determine its association with trauma readmissions, repeat falls, and mortality at 6 months. Methods: we performed a 2-year (2012-2013) prospective cohort analysis of all consecutive geriatric (age, ≥ 65 years) trauma patients. FS was assessed using a Trauma-Specific Frailty Index (TSFI). Patients were stratified into: nonfrail, TSFI ≤ 0.12; prefrail, TSFI = 0.1 to 0.27; and frail, TSFI > 0.27. Patient follow-up occurred at 6 months to assess outcomes. Regression analysis was performed to assess independent associations between TSFI and outcomes. Results: Three hundred fifty patients were enrolled. Frail patients were more likely to develop in-hospital complications (nonfrail, 12%; prefrail, 17.4%; and frail, 33.4%; p = 0.02) and an adverse discharge disposition compared with nonfrail and prefrail (nonfrail, 8%; prefrail,18%; and frail, 47%; p = 0.001). Six-month follow-up was recorded in 80% of the patients. Compared with nonfrail patients, frail patients were more likely to have had a trauma-related readmission (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-3.6) and/or repeated falls (OR, 1.6; 95%CI, 1.1-2.5) over the 6-month period. Overall 6-month mortality was 2.8% (n = 10), and frail elderly patients were more likely to have died (OR, 1.1; 95% CI, 1.04-4.7) compared with nonfrail patients. Conclusion: Over a third of geriatric trauma patients had FS. TSFI provides a practical and accurate assessment tool for identifying elderly trauma patients who are at increased risk of both short-term and long-term outcomes. Early focused intervention in frail geriatric patients is warranted to improve long-term outcomes. Level of Evidence: Prognostic study, level II.

AB - Background: Frailty syndrome (FS) is a well-established predictor of outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and to determine its association with trauma readmissions, repeat falls, and mortality at 6 months. Methods: we performed a 2-year (2012-2013) prospective cohort analysis of all consecutive geriatric (age, ≥ 65 years) trauma patients. FS was assessed using a Trauma-Specific Frailty Index (TSFI). Patients were stratified into: nonfrail, TSFI ≤ 0.12; prefrail, TSFI = 0.1 to 0.27; and frail, TSFI > 0.27. Patient follow-up occurred at 6 months to assess outcomes. Regression analysis was performed to assess independent associations between TSFI and outcomes. Results: Three hundred fifty patients were enrolled. Frail patients were more likely to develop in-hospital complications (nonfrail, 12%; prefrail, 17.4%; and frail, 33.4%; p = 0.02) and an adverse discharge disposition compared with nonfrail and prefrail (nonfrail, 8%; prefrail,18%; and frail, 47%; p = 0.001). Six-month follow-up was recorded in 80% of the patients. Compared with nonfrail patients, frail patients were more likely to have had a trauma-related readmission (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-3.6) and/or repeated falls (OR, 1.6; 95%CI, 1.1-2.5) over the 6-month period. Overall 6-month mortality was 2.8% (n = 10), and frail elderly patients were more likely to have died (OR, 1.1; 95% CI, 1.04-4.7) compared with nonfrail patients. Conclusion: Over a third of geriatric trauma patients had FS. TSFI provides a practical and accurate assessment tool for identifying elderly trauma patients who are at increased risk of both short-term and long-term outcomes. Early focused intervention in frail geriatric patients is warranted to improve long-term outcomes. Level of Evidence: Prognostic study, level II.

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KW - Geriatrics

KW - long-term outcomes

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