The impact of frailty in major trauma in older patients.
Accidental Falls
/ statistics & numerical data
Aged
Aged, 80 and over
Cause of Death
Female
Frail Elderly
Frailty
/ epidemiology
Humans
Injury Severity Score
Length of Stay
/ statistics & numerical data
Logistic Models
Male
Middle Aged
Multivariate Analysis
Patient Discharge
/ statistics & numerical data
Registries
Retrospective Studies
Risk Factors
Sex Factors
Trauma Centers
United Kingdom
Wounds and Injuries
Journal
Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
21
07
2019
revised:
10
04
2020
accepted:
25
04
2020
pubmed:
22
5
2020
medline:
19
3
2021
entrez:
22
5
2020
Statut:
ppublish
Résumé
As our population ages and increasing numbers of older patients experience major trauma it is important to understand factors that influence outcomes in this patient cohort. The aim of this study is to assess the impact of frailty in older patients who experience major trauma (Injury Severity Score (ISS) greater than 15). A retrospective cohort review using the national trauma registry data (Trauma Audit and Research Network) and an institutional database was carried out on all patients aged 60 years or older with an ISS> 15 who were treated at the regional Major Trauma Centre from 2014 to 2017 following major trauma. Frailty was assessed using the modified frailty index (mFI). Outcomes assessed included mortality, complications, hospital stay, functional outcome and discharge destination. 819 patients were included in the study. The most common mechanism of injury was fall from a height less than 2m (57.4%). 412 (51.3%) patients had a low frailty score, 280 (35%) had an intermediate frailty score and 110 (14%) had high frailty score. Increased frailty was associated with increased mortality at discharge (18.7%, 14.6% and 26.4% for low, intermediate and high frailty groups) and at one year (26.2%, 35.2% and 51%, respectively). Other predictors of mortality included male sex, age >90 years and the occurrence of a serious complication. Increasing frailty was also associated with an increased risk of serious complications including unplanned intubation, infection and progressive renal failure, and discharge to a destination other than home. This is the first study that has delineated the impact of frailty in older patients who experience major trauma and provides important information for patients, their families and healthcare providers. Future studies should focus on identifying care pathways that counteract the impact of frailty in this setting.
Identifiants
pubmed: 32434718
pii: S0020-1383(20)30392-2
doi: 10.1016/j.injury.2020.04.045
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1536-1542Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None.