TY - JOUR
T1 - Prospective validation and application of the Trauma-Specific Frailty Index
T2 - Results of an American Association for the Surgery of Trauma multi-institutional observational trial
AU - AAST Frailty MIT Study Group
AU - Joseph, Bellal
AU - Saljuqi, Abdul Tawab
AU - Amos, Joseph D.
AU - Teichman, Amanda
AU - Whitmill, Melissa L.
AU - Anand, Tanya
AU - Hosseinpour, Hamidreza
AU - Burruss, Sigrid K.
AU - Dunn, Julie A.
AU - Najafi, Kaveh
AU - Godat, Laura N.
AU - Enniss, Toby M.
AU - Shoultz, Thomas H.
AU - Egodage, Tanya
AU - Bongiovanni, Tasce
AU - Hazelton, Joshua P.
AU - Colling, Kristin
AU - Costantini, Todd W.
AU - Stein, Deborah M.
AU - Schroeppel, Thomas J.
AU - Nahmias, Jeffry
AU - El-Qawaqzeh, Khaled
AU - Choron, Rachel L.
AU - Comish, Paul B.
AU - Leneweaver, Kyle
AU - Palmer, Brandi
AU - Truitt, Michael S.
AU - Farrell, Mike
AU - Laufenberg, Lacee J.
AU - Lasso-Tay, Erica
AU - Stillman, Zachery
AU - Hass, Daniel T.
AU - Grossman, Heather M.
AU - Gordon, Darnell
AU - Krause, Cassandra
AU - Thomas, Jonathan
N1 - Publisher Copyright:
Copyright © 2022 American Association for the Surgery of Trauma.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - BACKGROUND: The frailty index is a known predictor of adverse outcomes in geriatric patients. Trauma-Specific Frailty Index (TSFI) was created and validated at a single center to accurately identify frailty and reliably predict worse outcomes among geriatric trauma patients. This study aims to prospectively validate the TSFI in a multi-institutional cohort of geriatric trauma patients. METHODS: This is a prospective, observational, multi-institutional trial across 17 American College of Surgeons Levels I, II, and III trauma centers. All geriatric trauma patients (65 years and older) presenting during a 3-year period were included. Frailty status was measured within 24 hours of admission using the TSFI (15 variables), and patients were stratified into nonfrail (TSFI, ≤0.12), prefrail (TSFI, 0.13–0.25), and frail (TSFI, >0.25) groups. Outcome measures included index admission mortality, discharge to rehabilitation centers or skilled nursing facilities (rehab/SNFs), and 3-month postdischarge readmissions, fall recurrences, complications, and mortality among survivors of index admission. RESULTS: A total of 1,321 geriatric trauma patients were identified and enrolled for validation of TSFI (nonfrail, 435 [33%]; prefrail, 392 [30%]; frail, 494 [37%]). The mean ± SD age was 77 ± 8 years; the median (interquartile range) Injury Severity Score was 9 (5–13). Overall, 179 patients (14%) had a major complication, 554 (42%) were discharged to rehab/SNFs, and 63 (5%) died during the index admission. Compared with nonfrail patients, frail patients had significantly higher odds of mortality (adjusted odds ratio [aOR], 1.93; p = 0.018), major complications (aOR, 3.55; p < 0.001), and discharge to rehab/SNFs (aOR, 1.98; p < 0.001). In addition, frailty was significantly associated with higher adjusted odds of mortality, major complications, readmissions, and fall recurrence at 3 months postdischarge (p < 0.05). CONCLUSION: External applicability of the TSFI (15 variables) was evident at a multicenter cohort of 17 American College of Surgeons trauma centers in geriatric trauma patients. The TSFI emerged as an independent predictor of worse outcomes, both in the short-term and 3-month postdischarge.
AB - BACKGROUND: The frailty index is a known predictor of adverse outcomes in geriatric patients. Trauma-Specific Frailty Index (TSFI) was created and validated at a single center to accurately identify frailty and reliably predict worse outcomes among geriatric trauma patients. This study aims to prospectively validate the TSFI in a multi-institutional cohort of geriatric trauma patients. METHODS: This is a prospective, observational, multi-institutional trial across 17 American College of Surgeons Levels I, II, and III trauma centers. All geriatric trauma patients (65 years and older) presenting during a 3-year period were included. Frailty status was measured within 24 hours of admission using the TSFI (15 variables), and patients were stratified into nonfrail (TSFI, ≤0.12), prefrail (TSFI, 0.13–0.25), and frail (TSFI, >0.25) groups. Outcome measures included index admission mortality, discharge to rehabilitation centers or skilled nursing facilities (rehab/SNFs), and 3-month postdischarge readmissions, fall recurrences, complications, and mortality among survivors of index admission. RESULTS: A total of 1,321 geriatric trauma patients were identified and enrolled for validation of TSFI (nonfrail, 435 [33%]; prefrail, 392 [30%]; frail, 494 [37%]). The mean ± SD age was 77 ± 8 years; the median (interquartile range) Injury Severity Score was 9 (5–13). Overall, 179 patients (14%) had a major complication, 554 (42%) were discharged to rehab/SNFs, and 63 (5%) died during the index admission. Compared with nonfrail patients, frail patients had significantly higher odds of mortality (adjusted odds ratio [aOR], 1.93; p = 0.018), major complications (aOR, 3.55; p < 0.001), and discharge to rehab/SNFs (aOR, 1.98; p < 0.001). In addition, frailty was significantly associated with higher adjusted odds of mortality, major complications, readmissions, and fall recurrence at 3 months postdischarge (p < 0.05). CONCLUSION: External applicability of the TSFI (15 variables) was evident at a multicenter cohort of 17 American College of Surgeons trauma centers in geriatric trauma patients. The TSFI emerged as an independent predictor of worse outcomes, both in the short-term and 3-month postdischarge.
KW - frailty
KW - Geriatric trauma
KW - long-term outcomes
KW - readmission
KW - recurrent fall
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U2 - 10.1097/TA.0000000000003817
DO - 10.1097/TA.0000000000003817
M3 - Article
C2 - 36279368
AN - SCOPUS:85145425869
SN - 2163-0755
VL - 94
SP - 36
EP - 44
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -