Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer?

The frailty index (FI) has been shown to predict outcomes in geriatric patients. However, FI has never been applied as a prognostic measure after trauma. The aim of our study was to identify hospital admission factors predicting discharge disposition in geriatric trauma patients. We performed a 1-ye...

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Published inThe journal of trauma and acute care surgery Vol. 76; no. 1; p. 196
Main Authors Joseph, Bellal, Pandit, Viraj, Rhee, Peter, Aziz, Hassan, Sadoun, Moutamn, Wynne, Julie, Tang, Andrew, Kulvatunyou, Narong, O'Keeffe, Terence, Fain, Mindy J, Friese, Randall S
Format Journal Article
LanguageEnglish
Published United States 01.01.2014
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Abstract The frailty index (FI) has been shown to predict outcomes in geriatric patients. However, FI has never been applied as a prognostic measure after trauma. The aim of our study was to identify hospital admission factors predicting discharge disposition in geriatric trauma patients. We performed a 1-year prospective study at our Level 1 trauma center. All trauma patients 65 years or older were enrolled. FI was calculated using 50 preadmission variables. Patient's discharge disposition was dichotomized as favorable outcome (discharge home, rehabilitation) or unfavorable outcomes (discharge to skilled nursing facility, death). Multivariate logistic regression was performed to identify factors that predict unfavorable outcome. A total of 100 patients were enrolled, with a mean (SD) age of 76.51 (8.5) years, 59% being males, median Injury Severity Score (ISS) of 14 (range, 9-18), median head Abbreviated Injury Scale (h-AIS) score of 2 (2-3), and median Glasgow Coma Scale (GCS) score of 13 (12-15). Of the patients, 69% had favorable outcome, and 31% had unfavorable outcome. On univariate analysis, FI was found to be a significant predictor for unfavorable outcome (odds ratio, 1.8; 95% confidence interval, 1.2-2.3). After adjusting for age, ISS, and GCS score in a multivariate regression model, FI remained a strong predictor for unfavorable discharge disposition (odds ratio, 1.3; 95% confidence interval, 1.1-1.8). The concept of frailty can be implemented in geriatric trauma patients with similar results as those of nontrauma and nonsurgical patients. FI is a significant predictor of unfavorable discharge disposition and should be an integral part of the assessment tools to determine discharge disposition for geriatric trauma patients. Prognostic study, level II.
AbstractList The frailty index (FI) has been shown to predict outcomes in geriatric patients. However, FI has never been applied as a prognostic measure after trauma. The aim of our study was to identify hospital admission factors predicting discharge disposition in geriatric trauma patients. We performed a 1-year prospective study at our Level 1 trauma center. All trauma patients 65 years or older were enrolled. FI was calculated using 50 preadmission variables. Patient's discharge disposition was dichotomized as favorable outcome (discharge home, rehabilitation) or unfavorable outcomes (discharge to skilled nursing facility, death). Multivariate logistic regression was performed to identify factors that predict unfavorable outcome. A total of 100 patients were enrolled, with a mean (SD) age of 76.51 (8.5) years, 59% being males, median Injury Severity Score (ISS) of 14 (range, 9-18), median head Abbreviated Injury Scale (h-AIS) score of 2 (2-3), and median Glasgow Coma Scale (GCS) score of 13 (12-15). Of the patients, 69% had favorable outcome, and 31% had unfavorable outcome. On univariate analysis, FI was found to be a significant predictor for unfavorable outcome (odds ratio, 1.8; 95% confidence interval, 1.2-2.3). After adjusting for age, ISS, and GCS score in a multivariate regression model, FI remained a strong predictor for unfavorable discharge disposition (odds ratio, 1.3; 95% confidence interval, 1.1-1.8). The concept of frailty can be implemented in geriatric trauma patients with similar results as those of nontrauma and nonsurgical patients. FI is a significant predictor of unfavorable discharge disposition and should be an integral part of the assessment tools to determine discharge disposition for geriatric trauma patients. Prognostic study, level II.
Author Rhee, Peter
Kulvatunyou, Narong
Sadoun, Moutamn
O'Keeffe, Terence
Pandit, Viraj
Tang, Andrew
Aziz, Hassan
Wynne, Julie
Joseph, Bellal
Fain, Mindy J
Friese, Randall S
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Snippet The frailty index (FI) has been shown to predict outcomes in geriatric patients. However, FI has never been applied as a prognostic measure after trauma. The...
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StartPage 196
SubjectTerms Abbreviated Injury Scale
Age Factors
Aged
Aged, 80 and over
Female
Frail Elderly - statistics & numerical data
Glasgow Coma Scale
Health Status
Humans
Injury Severity Score
Male
Patient Discharge - statistics & numerical data
Prospective Studies
Trauma Centers - statistics & numerical data
Treatment Outcome
Wounds and Injuries - mortality
Wounds and Injuries - therapy
Title Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer?
URI https://www.ncbi.nlm.nih.gov/pubmed/24368379
Volume 76
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