Q. Alizai1, T. Anand1, S. Bhogadi1, C. Colosimo1, O. Hejazi1, A. L. Spencer1, H. Hosseinpour1, M. Ditillo1, L. J. Magnotti1, B. Joseph1 1University Of Arizona, Division Of Trauma, Critical Care, Burns, And Emergency Surgery, Department Of Surgery, Tucson, AZ, USA
Introduction: Although there has been an ongoing effort to define the futility of resuscitation, there is a paucity of data on the objective measures of the predictors of futility, especially among geriatric trauma patients, to guide physicians and patients’ families on end-of-life care. The aim of this study was to validate our recently developed scoring system (Futility of Resuscitation Measure [FoRM]) for predicting the futility of resuscitation among geriatric trauma patients.
Methods: This is a retrospective analysis of an ACS level I trauma registry database over 5 years (2017-2022). We included all geriatric (≥65 years) trauma patients admitted to our level I trauma center. We excluded patients who had withdrawal of life-supporting treatment. Frailty was identified using the 11-factor modified frailty index (mFI ≥0.27). Patients were stratified into decades of age and resuscitative endpoints and interventions employed were identified, including lowest in-hospital systolic blood pressure (≤1 hour), prehospital cardiac arrest, 4-hour PRBC transfusion requirements, emergency department (ED) resuscitative thoracotomy, resuscitative endovascular balloon occlusion of the aorta (REBOA), emergency laparotomy (≤2 hours), the early vasopressor requirement (≤6 hours), severe traumatic brain injury (GCS≤8), TBI midline shift, and craniectomy. We performed a sensitivity analysis to identify the predictive ability of FoRM.
Results: A total of 6,407 geriatric trauma patients were identified. The mean (SD) age was 77 (8) years, 52% of patients were male, 13% were frail, median [IQR] ISS was 5 [1 – 10], and mean (SD) SBP was 146 (29) mm Hg. Overall, 29 (0.5%) patients had prehospital cardiac arrest, 731 (11%) had an episode of hypotension <50 mm Hg, 129 (2%) had severe TBI with GCS≤8, 136 (2.1%) had TBI midline shift, and 68 (1.1%) patients received more than 5 units of PRBC within 4 hours of arrival. Among all patients, only two underwent ED thoracotomy, and no patient received REBOA. Overall mortality was 3.4%. The FoRM was validated (Figure) (AUROC 0.763, p<0.001). FoRM score >13 was associated with mortality greater than 90%.
Conclusion: FoRM can identify the risk of futile resuscitation among all geriatric patients admitted to our level I trauma center. Prospective multi-institutional assessment and evaluation of this scoring system will help to objectively guide resuscitation and end-of-life decision-making for healthcare providers, patients, and their families.
