Redefining the association between old age and poor outcomes after trauma: The impact of Frailty Syndrome.

BACKGROUND: Frailty syndrome (FS) is a well-established predictor of outcomes in geriatric patients. Aim of this study was to quantify the prevalence of frailty syndrome (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 yrs.) trauma patients. FS was assessed using a trauma specific frailty index (TSFI). Patients were stratified into: Non-frail: TSFI 0.27. Patient follow up occurred at six months to assess outcomes. Regression analysis was performed to assess independent associations between TSFI and outcomes. RESULTS: 350 patients were enrolled. Frail patients were more likely to develop in-hospital complications (non-frail: 12%, pre-frail: 17.4%, and frail: 33.4%, p=0.02) and an adverse discharge disposition compared to non-frail and pre-frail (non-frail: 8%, pre-frail:18%, and frail: 47%, p=0.001). Six-month follow up was recorded in 80% of the patients. Compared to non-frail patients frail patients were more likely to have had a trauma-related readmission (OR [95%CI], 1.4 [1.2-3.6]) and/or repeated falls (OR [95%CI], 1.6 [1.1-2.5]) over the six month period. Overall six month mortality was 2.8% (n=10) and frail elderly patients were more likely to have died (OR [95%CI], 1.1 [1.04-4.7]) compared to non-frail 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- and long-term outcomes. Early focused intervention in frail geriatric patients is warranted to improve long term outcomes. LEVEL OF EVIDENCE: Level II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease (C) 2016 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2iz9qDt