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Frailty 'most important factor' affecting trauma outcome

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Frailty prior to admission appears to be the key factor affecting negative outcomes among older patients who have experienced trauma, a Canadian study has highlighted.

More than age or the severity of the injury, pre-admission frailty was associated with mortality, transfer to another acute hospital or care home, according to the study.

“Worse outcomes in this population cannot solely be explained by their advanced age”

Camilla Wong

The researchers measured frailty upon admission to hospital with the Clinical Frailty Scale – a clinical assessment tool that uses data on cognition, mobility, function and comorbidities.

They found that of the 260 patients studied, 11 died in hospital, 71 were transferred to another acute care hospital and 11 were transferred to a chronic-care or long-term care facility.

In addition, 71% of patients with pre-admission frailty were transferred to another hospital or long-term care facility, or died, compared with only 28% of patients without pre-admission frailty.

Lead study author Dr Camilla Wong, a geriatrician at St. Michael’s Hospital in Toronto, said: “Older trauma patients, in general, have worse outcomes than younger patients, with higher mortality, higher complication rates, longer hospital stays, and an increased likelihood of being transferred to a long-term care facility.

“Worse outcomes in this population cannot solely be explained by their advanced age,” she said. “We found that the increased vulnerability to negative outcomes among older trauma patients is likely due in large part to frailty.”

The study authors added that the scale they used, which was developed based on data from the Canadian Study of Health and Aging, could potentially fill a gap in effective frailty assessment tools.

They noted that a previous research evaluating clinical assessment tools had concluded there was a lack of objective, feasible and useful measures to assess frailty in geriatric trauma patients.

St. Michael's Hospital

Frailty more important factor than age for trauma outcome

Source: St. Michael’s Hospital

Camilla Wong

Dr Wong said: “This tool allowed us to identify frailty when a patient is admitted, and can be easily implemented and used to guide management and decision making in the geriatric trauma population.”

She also suggested the scale had the potential to be used to help improve outcomes in older adults after trauma.

Dr Wong said: “This study demonstrates the Clinical Frailty Scale can identify older adults at risk of adverse outcomes after injury and can enable clinicians to better triage patients and manage resources for this population.

“This is crucial for geriatric trauma patients, as they are at greater risk of negative outcomes, both in the short- and long-term,” she added.

The study findings have been published this week in the Journal of the American College of Surgeons.

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