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.

Aged Aged, 80 and over England / epidemiology Female Frailty / epidemiology Geriatric Assessment Humans Male Trauma Centers

Journal

The lancet. Healthy longevity
ISSN: 2666-7568
Titre abrégé: Lancet Healthy Longev
Pays: England
ID NLM: 101773309

Informations de publication

Date de publication:
08 2022
Historique:
received: 14 02 2022
revised: 09 05 2022
accepted: 12 05 2022
entrez: 14 9 2022
pubmed: 15 9 2022
medline: 17 9 2022
Statut: ppublish

Résumé

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. 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). 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]). 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. None.

Sections du résumé

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.

Identifiants

DOI: 10.1016/S2666-7568(22)00122-2 PMID: 36102763
pubmed: 36102763
pii: S2666-7568(22)00122-2
doi: 10.1016/S2666-7568(22)00122-2
pii:
doi:

Types de publication

Journal Article Multicenter Study Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e540-e548

Subventions

Organisme : Department of Health
Pays : United Kingdom

Informations de copyright

Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests 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.

Auteurs

Ben Carter (B)

CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Roxanna Short (R)

CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Omar Bouamra (O)

The Trauma Audit and Research Network, The University of Manchester, Salford Royal - Northern Care Alliance NHS Foundation Trust, Salford, UK.

Frances Parry (F)

CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.

David Shipway (D)

CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.

Julian Thompson (J)

CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Severn Major Trauma Network, UK.

Mark Baxter (M)

Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK.

Fiona Lecky (F)

The Trauma Audit and Research Network, The University of Manchester, Salford Royal - Northern Care Alliance NHS Foundation Trust, Salford, UK; Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK; Emergency Department, Salford Royal Hospital, Salford, UK.

Philip Braude (P)

CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK. Electronic address: philip.braude@nbt.nhs.uk.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › A national study of 23 major trauma centres to...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › A national study of 23 major trauma centres to...
questionsmedicales.fr › Régions géographiques › Europe › Royaume-Uni › Angleterre › A national study of 23 major trauma centres to...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Fragilité › A national study of 23 major trauma centres to...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Évaluation gériatrique › A national study of 23 major trauma centres to...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A national study of 23 major trauma centres to...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › Centres de traumatologie › A national study of 23 major trauma centres to...