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A national study of 23 major trauma centres to investigate the effect of frailty on clinical outcomes in older people admitted with serious injury in England (FiTR 1): a multicentre observational study

Research output: Contribution to journalArticlepeer-review

Ben Carter, Roxanna Short, Omar Bouamra, Frances Parry, David Shipway, Julian Thompson, Mark Baxter, Fiona Lecky, Philip Braude

Original languageEnglish
Pages (from-to)e540-e548
JournalThe Lancet Healthy Longevity
Volume3
Issue number8
Early online date4 Jul 2022
DOIs
Accepted/In press12 May 2022
E-pub ahead of print4 Jul 2022
Published1 Aug 2022

Bibliographical note

Funding Information: FL receives renumeration as a research director for TARN, which is funded through member NHS hospitals and hospitals in Ireland by recurrent annual subscription. DS has received reimbursement for expert testimony in matters relation to geriatric trauma for the UK courts from UK National Health Service resolution, HM coroner, and instructing litigant or defendant parties. All other authors declare no competing interests. Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

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Abstract

Background: Older people are the largest group admitted to hospital with serious injuries. Many older people are living with frailty, a risk factor for poor recovery. We aimed to examine the effect of preinjury frailty on outcomes. Methods: In this multicentre observational study (FiTR 1), we extracted prospectively collected data from all 23 adult major trauma centres in England on older people (aged ≥65 years) admitted with serious injuries over a 2·5 year period from the Trauma Audit and Research Network (TARN) database. Geriatricians assessed the preinjury Clinical Frailty Scale (CFS), a 9-point scale of fitness and frailty, with a score of 1 indicating a patient is very fit and a score of 9 indicating they are terminally ill. The primary outcome was inpatient mortality, with patients censored at hospital discharge. We used a multi-level Cox regression model fitted with adjusted hazards ratios (aHRs) to assess the association between CFS and mortality, with CFS scores being grouped as follows: a score of 1–2 indicated patients were fit; a score of 3 indicated patients were managing well; and a score of 4–8 indicated patients were living with frailty (4 being very mild, 5 being mild, 6 being moderate, and 7–8 being severe). Findings: Between March 31, 2019, and Oct 31, 2021, 193 156 patients had records were held by TARN, of whom 16 504 had eligible records. Median age was 81·9 years (IQR 74·7–88·0), 9200 (55·7%) were women, and 7304 (44·3%) were men. Of 16 438 patients with a CFS score of 1–8, 11 114 (67·6%) were living with frailty (CFS of 4–8). 1660 (10·1%) patients died during their hospital stay, with a median time from admission to death of 9 days (IQR 4–18). Compared in patients with a CFS score of 1–2, risk of inpatient death was increased in those managing well (CFS score of 3; aHR 1·82 [95% CI 1·39–2·40]), living with very mild frailty (CFS score of 4: 1·99 [1·51–2·62]), living with mild frailty (CFS score of 5: 2·61 [1·99–3·43]), living with moderate frailty (CFS score of 6: 2·97 [2·26–3·90]), and living with severe frailty (CFS score of 7–8: 4·03 [3·04–5·34]). Interpretation: Our findings support inclusion of the CFS in trauma pathways to aid patient management. Additionally, people who exercise regularly (CFS of 1–2) have better outcomes than those with lower activity levels (CFS of ≥3), supporting exercise as an intervention to improve trauma outcomes. Funding: None.

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