Does frailty scoring help to predict outcomes in older patients with major trauma? A retrospective study at a major trauma centre

Abstract

Objective: The objective of the present study was to evaluate the impact of frailty on outcomes for older patients presenting with major trauma to a tertiary ED in Aotearoa New Zealand. Methods: A retrospective observational study of patients 65 years and older who presented to Christchurch ED, New Zealand, with major trauma between 1 January and 31 December 2022. The primary outcome was a composite of in-hospital mortality or increased care requirements on discharge from hospital. Demographic details, in-hospital management, and outcomes were retrieved. Clinical Frailty Scale scoring had prospectively been recorded at the time of admission. Univariable analysis of discrete dependent variables was carried out. Mediation analysis was undertaken, wherein frailty was the mediator between age and the primary outcome variable. Results: After exclusion criteria were applied, 134 patients were included for analysis. Even after controlling for age, for every additional point on the Clinical Frailty Scale, the odds of in-hospital mortality or increased care requirements on discharge increased by 36.4% (95% confidence interval: 9.4–85). Only 33% of these major trauma patients were appropriately identified at presentation and so received a trauma team activation, with worsened activation rates with increasing frailty. Conclusions: The presence of significant injuries in older trauma patients is under-recognised. Frailty scoring could be used in the ED for early identification of those patients at high risk of poor outcomes, so that active management strategies can be put in place to optimise their care.