Frailty score on admission predicts mortality and discharge disposition in elderly trauma patients over the age of 65 y.

ABSTRACT

BACKGROUND: Although many frailty scales exist, a single scale has not been agreed upon to define frailty. Herein, we determined whether the Canadian Study on Health and Aging Clinical Frailty Scale (CSHA CFS) can predict the risk of elderly patients for hospital mortality and discharge to skilled nursing facilities (SNFs) following traumatic injury. METHODS: Charts from trauma patients aged ≥65 y admitted from December 1, 2011 to December 31, 2013 were retrospectively examined. Age, mechanism of injury, Glasgow coma score, systolic blood pressure and heart rate on arrival, injury severity score, hospital mortality, length of stay, and discharge disposition were recorded. Frailty scores were determined from admission data using the CSHA CFS. Univariate and multivariate analyses were performed. RESULTS: A total of 1403 patients were included. The mean age was 77.6 ± 8.6 y. Patients with falls presented higher frailty scores than patients who sustained injuries through other mechanisms (4.58 ± 1.2 versus 3.52 ± 1.15; P < 0.00001) and were significantly older (79.5 ± 8.6 versus 73.4 ± 7.4; P <0.00001). Frailty scores of nonsurvivors were significantly higher than those of survivors (4.6 ± 1.3 versus 4.2 ± 1.2; P <0.01). Age, Glasgow coma score, and CSHA CFS combined were associated with mortality (odds ratio 1.52; confidence interval 1.37-1.69). A higher frailty score was associated with earlier death and increased mortality. CONCLUSIONS: CSHA CFS is simple and provides frailty scores that can help identifying elderly patients at high risk for in-hospital mortality and discharge to SNF following traumatic injury.