They’re Only as Old as They Feel: Frailty Predicts Outcome Better Than Age in Trauma

Authors: Joseph B et al., JAMA Surg 2014 Jun 11;

Older trauma patients who were frail were more likely to have in-hospital complications and adverse discharge dispositions than those who were not frail.

Although advancing age is associated with worse outcomes in trauma patients (NEJM JW Emerg Med Oct 27 2004 and NEJM JW Emerg Med Nov 12 2010), some studies indicate that patient health status also greatly influences outcome (NEJM JW Emerg Med Jun 1 1998). To determine whether frailty is associated with in-hospital complications and adverse discharge dispositions (mortality or discharge to a skilled nursing facility) in trauma patients aged 65 years or older, researchers used the 50-item Canadian Frailty Index, which assesses demographics, social activity, activities of daily living, nutrition, and mood.

Of 250 patients (mean age, 78), 110 (44%) were frail. Frail patients were more likely to have in-hospital complications (37% vs. 21%; most commonly urinary tract infections) and adverse discharge dispositions (37% vs. 13%). Five patients died, all of whom were frail. While other factors (including older age, male sex, higher systolic blood pressure, lower Glasgow Coma Scale score, and higher Injury Severity Score) were also associated with worse outcomes, only frailty was significantly predictive in multivariate analysis.

Comment

These results make sense, and the authors are to be commended for bringing frailty into the spotlight. However, we cannot use a 50-item scale during the acute management of trauma patients. Instead, these findings should remind us to consider frailty rather than age alone when determining best treatment plans for patients with trauma and to discuss the potential implications of frailty with our less-active older patients and their families.