Frailty is associated with long-term outcomes in older trauma patients: A prospective cohort study

TY - JOUR

T1 - Frailty is associated with long-term outcomes in older trauma patients

T2 - A prospective cohort study

AU - Ibitoye, Sarah

AU - Bridgeman-Rutledge, Lily

AU - Short, Roxanna

AU - Braude, Philip

AU - Pocock, Lucy

AU - Carter, Ben

N1 - Funding Information: No funding or conflicts of interest. Publisher Copyright: © 2023

PY - 2023/12/8

Y1 - 2023/12/8

N2 - Background: Most major trauma admissions are older adults, many of whom are living with frailty - a recognised risk factor for post-injury mortality. Objectives: To describe the effect of frailty, and geriatrician review on mortality up to 4-years after hospitalisation following trauma. Methods: This prospective cohort study included patients 65 years or older admitted to North Bristol NHS Trusts’ Major Trauma Centre from November 2018 to September 2019. The primary outcome was time-to-mortality, assessed with an adjusted multivariable Cox regression model. Analyses were adjusted for factors known to be associated with mortality including age, sex, comorbidities, injury factors, surgical procedure, and complications. Results: 573 patients were included: median age was 81 years; 67.5 % were living with frailty (Clinical Frailty Scale, CFS 4–8). Mortality was 45.2 % at the end of the study. Compared to fit patients (CFS 1-2), risk of death increased in those living with very mild frailty (CFS 4; aHR 3.22 [95 % CI 1.53–6.77]), mild frailty (CFS 5; aHR 4.97 [95 % CI 2.40–10.28]), moderate frailty (CFS 6; aHR 5.94 [95 % CI 2.83–12.44]), and moderate to severe frailty (CFS 7–8; aHR 9.63 [95 % CI 4.35–21.32]). Geriatrician review was associated with less mortality (aHR 0.55, 95 % CI 0.38–0.79). Conclusions: Frailty predicts long-term mortality in older trauma. Our findings have implications for clinician-patient discussions of prognosis and therapy goals. Furthermore, our results lend support to the routine provision of geriatrician input in trauma pathways.

AB - Background: Most major trauma admissions are older adults, many of whom are living with frailty - a recognised risk factor for post-injury mortality. Objectives: To describe the effect of frailty, and geriatrician review on mortality up to 4-years after hospitalisation following trauma. Methods: This prospective cohort study included patients 65 years or older admitted to North Bristol NHS Trusts’ Major Trauma Centre from November 2018 to September 2019. The primary outcome was time-to-mortality, assessed with an adjusted multivariable Cox regression model. Analyses were adjusted for factors known to be associated with mortality including age, sex, comorbidities, injury factors, surgical procedure, and complications. Results: 573 patients were included: median age was 81 years; 67.5 % were living with frailty (Clinical Frailty Scale, CFS 4–8). Mortality was 45.2 % at the end of the study. Compared to fit patients (CFS 1-2), risk of death increased in those living with very mild frailty (CFS 4; aHR 3.22 [95 % CI 1.53–6.77]), mild frailty (CFS 5; aHR 4.97 [95 % CI 2.40–10.28]), moderate frailty (CFS 6; aHR 5.94 [95 % CI 2.83–12.44]), and moderate to severe frailty (CFS 7–8; aHR 9.63 [95 % CI 4.35–21.32]). Geriatrician review was associated with less mortality (aHR 0.55, 95 % CI 0.38–0.79). Conclusions: Frailty predicts long-term mortality in older trauma. Our findings have implications for clinician-patient discussions of prognosis and therapy goals. Furthermore, our results lend support to the routine provision of geriatrician input in trauma pathways.

KW - Frailty

KW - Geriatric assessment

KW - Mortality

KW - Older people

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=85180496126&partnerID=8YFLogxK

U2 - 10.1016/j.injury.2023.111265

DO - 10.1016/j.injury.2023.111265

M3 - Article

C2 - 38101198

AN - SCOPUS:85180496126

SN - 0020-1383

VL - 55

JO - Injury

JF - Injury

IS - 2

M1 - 111265

ER -