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

Bellal Joseph, Viraj Pandit, Peter Rhee, Hassan Aziz, Moutamn Sadoun, Julie Wynne, Andrew Tang, Narong Kulvatunyou, Terence OKeeffe, Mindy J. Fain, Randall S. Friese

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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, 9Y18), median head Abbreviated Injury Scale (h-AIS) score of 2 (2Y3), and median Glasgow Coma Scale (GCS) score of 13 (12Y15). 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, 1.2Y2.3). 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, 1.1Y1.8). CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)196-200
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Geriatrics
Wounds and Injuries
Glasgow Coma Scale
Injury Severity Score
Odds Ratio
Abbreviated Injury Scale
Confidence Intervals
Skilled Nursing Facilities
Patient Discharge
Trauma Centers
Craniocerebral Trauma
Rehabilitation
Logistic Models
Prospective Studies

Keywords

  • Discharge disposition
  • Frailty
  • Frailty index
  • Geriatric trauma
  • Physiologic reserve

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Predicting hospital discharge disposition in geriatric trauma patients : Is frailty the answer? / Joseph, Bellal; Pandit, Viraj; Rhee, Peter; Aziz, Hassan; Sadoun, Moutamn; Wynne, Julie; Tang, Andrew; Kulvatunyou, Narong; OKeeffe, Terence; Fain, Mindy J.; Friese, Randall S.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 1, 01.01.2014, p. 196-200.

Research output: Contribution to journalArticle

Joseph, B, Pandit, V, Rhee, P, Aziz, H, Sadoun, M, Wynne, J, Tang, A, Kulvatunyou, N, OKeeffe, T, Fain, MJ & Friese, RS 2014, 'Predicting hospital discharge disposition in geriatric trauma patients: Is frailty the answer?', Journal of Trauma and Acute Care Surgery, vol. 76, no. 1, pp. 196-200. https://doi.org/10.1097/TA.0b013e3182a833ac
Joseph, Bellal ; Pandit, Viraj ; Rhee, Peter ; Aziz, Hassan ; Sadoun, Moutamn ; Wynne, Julie ; Tang, Andrew ; Kulvatunyou, Narong ; OKeeffe, Terence ; Fain, Mindy J. ; Friese, Randall S. / Predicting hospital discharge disposition in geriatric trauma patients : Is frailty the answer?. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 1. pp. 196-200.
@article{066860fae45a4e5e9408e65a3bde3f7c,
title = "Predicting hospital discharge disposition in geriatric trauma patients: Is frailty the answer?",
abstract = "BACKGROUND: 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. METHODS: 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. RESULTS: 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, 9Y18), median head Abbreviated Injury Scale (h-AIS) score of 2 (2Y3), and median Glasgow Coma Scale (GCS) score of 13 (12Y15). 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, 1.2Y2.3). 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, 1.1Y1.8). CONCLUSION: 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.",
keywords = "Discharge disposition, Frailty, Frailty index, Geriatric trauma, Physiologic reserve",
author = "Bellal Joseph and Viraj Pandit and Peter Rhee and Hassan Aziz and Moutamn Sadoun and Julie Wynne and Andrew Tang and Narong Kulvatunyou and Terence OKeeffe and Fain, {Mindy J.} and Friese, {Randall S.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1097/TA.0b013e3182a833ac",
language = "English (US)",
volume = "76",
pages = "196--200",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Predicting hospital discharge disposition in geriatric trauma patients

T2 - Is frailty the answer?

AU - Joseph, Bellal

AU - Pandit, Viraj

AU - Rhee, Peter

AU - Aziz, Hassan

AU - Sadoun, Moutamn

AU - Wynne, Julie

AU - Tang, Andrew

AU - Kulvatunyou, Narong

AU - OKeeffe, Terence

AU - Fain, Mindy J.

AU - Friese, Randall S.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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, 9Y18), median head Abbreviated Injury Scale (h-AIS) score of 2 (2Y3), and median Glasgow Coma Scale (GCS) score of 13 (12Y15). 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, 1.2Y2.3). 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, 1.1Y1.8). CONCLUSION: 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.

AB - BACKGROUND: 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. METHODS: 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. RESULTS: 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, 9Y18), median head Abbreviated Injury Scale (h-AIS) score of 2 (2Y3), and median Glasgow Coma Scale (GCS) score of 13 (12Y15). 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, 1.2Y2.3). 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, 1.1Y1.8). CONCLUSION: 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.

KW - Discharge disposition

KW - Frailty

KW - Frailty index

KW - Geriatric trauma

KW - Physiologic reserve

UR - http://www.scopus.com/inward/record.url?scp=84892154378&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892154378&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3182a833ac

DO - 10.1097/TA.0b013e3182a833ac

M3 - Article

C2 - 24368379

AN - SCOPUS:84892154378

VL - 76

SP - 196

EP - 200

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -