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

Sarah Ibitoye*, Lily Bridgeman-Rutledge, Roxanna Short, Lucy V Pocock, Ben Carter

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

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.
Original languageEnglish
Article number111265
JournalInjury
Volume55
Issue number2
Early online date8 Dec 2023
DOIs
Publication statusPublished - 1 Feb 2024

Bibliographical note

Crown Copyright © 2023 Published by Elsevier Ltd. All rights reserved.

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