E. Curtis1, K. S. Romanowski2, S. Sen1, A. Hill3, C. Cocanour1 1University Of California – Davis,Department Of Surgery,Sacramento, CA, USA 2University Of Iowa,Department Of Surgery,Iowa City, IA, USA 3University Of California – Davis,Clinical Diagnostic Epidemiology,Davis, CA, USA
Introduction: Chronologic age alone does not define the frailty of a patient. There are many measures of frailty and a single measure has not been agreed upon as defining frailty. Many measures of frailty are time-consuming and require the collection of data that is not readily available in the medical chart. This study examines whether the Canadian Study on Health and Aging Clinical Frailty Scale (CSHA CFS), a simple 7 point clinical opinion scale, can help predict elderly patients at high risk from hospital mortality and discharge to skilled nursing facilities following traumatic injury.
Methods: Following IRB approval the charts of trauma patients >65 years old who admitted from 12/1/2011 to 12/31/2013 were examined. Data abstracted included 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. Frailty scores were assessed from admission data and calculated using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA CFS). Univariate, followed by Multivariate analysis of each of the variables listed and their effects on discharge disposition were examined.
Results: A total of 1403 patients were included in the study population. The mean age was 77.6 ± 8.6 years. Of all the patients admitted, 1385 (98.7%) patients had blunt injuries, these included 930 (66.3%) for falls, 272 (19.3%) for motor vehicle accidents, and 51 (3.6%) were pedestrians hit by cars. The mean CSHA CFS of the entire population was 4.23 ± 1.25. CSHA CFS was significantly higher in patients with falls (4.58 ± 1.2) compared to all other mechanisms (3.52 ±1.15) (p<.00001). Patients who fell were also significantly older (79.5±8.6 vs 73.4 ±7.4) (p<.00001). Non-survivors had significantly increased CSHA CFS (4.6 ± 1.3) compared to survivors (4.2 ± 1.2) (p<.01). The best-fitting multivariable logistic regression for mortality included age, GCS, and CSHA CFS, which had an odds ratio of 1.52(1.37-1.69). Cox proportional hazard models showed that a higher CSHA CFS was associated with earlier death and increased mortality.
Conclusions: Admission frailty scores allow for an improved assessment of pre-injury physiologic condition in trauma patients ≥65 years. Poor pre-injury physiologic fitness increases the risk of mortality in trauma patients ≥65 years. CSHA CFS is a simple to obtain frailty score that can help identify elderly patients at high risk for in-hospital mortality and discharge to skilled nursing facilities following traumatic injury.