The impact of frailty on failure-to-rescue in geriatric trauma patients: A prospective study

Bellal Joseph, Herb Phelan, Ahmed Hassan, Tahereh Orouji Jokar, Terence OKeeffe, Asad Azim, Lynn Gries, Narong Kulvatunyou, Rifat Latifi, Peter Rhee

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

INTRODUCTION Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients. METHODS We performed a prospective cohort study of all elderly (age ≥ 65 years) trauma patients presenting at our level one trauma center. Patient's frailty status was calculated utilizing the Trauma Specific Frailty Index (TSFI) within 24 hours of admission. Patients were stratified into non-frail, pre-frail, and frail. FTR was defined as death from a major complication (respiratory, infectious, cardiac, and renal). Binary logistic regression analysis was performed after adjusting for age, gender, injury severity (ISS), and vital parameters to assess the relationship between frailty status and FTR. RESULTS A total of 368 elderly trauma patients were evaluated of which 25% (n = 93) were non-frail, 38% (n = 139) pre-frail, and 37% (n = 136) frail. Overall, 30% of the patients developed in-hospital complications; of them, mortality occurred in 26% of the patients (FTR group). In the FTR group, 69% of the patients were frail compared to 17% pre-frail and 14% non-frail (p = 0.002). On multivariate regression analysis for predictors of FTR, frail status was an independent predictor of FTR (OR [95% CI] = 2.67 [1.37-5.20]; p = 0.004). On sensitivity analysis, positive predictive value of TSFI for FTR was 69% and negative predictive value for FTR was 67%. CONCLUSION In elderly trauma patients, the presence of frailty increased the odds of FTR almost threefold as compared to non-frail. Although FTR has been considered as an indicator of health care quality, the findings of this study suggest that frailty status independently contributes to FTR. This needs to be considered in the future development of quality metrics, particularly in the case of geriatric trauma patients.

Original languageEnglish (US)
Pages (from-to)1150-1155
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number6
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

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Geriatrics
Prospective Studies
Wounds and Injuries
Regression Analysis
Frail Elderly
Health Care Quality Indicators
Trauma Centers
Cohort Studies
Multivariate Analysis
Logistic Models
Kidney
Mortality

Keywords

  • failure to rescue (FTR)
  • Frailty
  • geriatric
  • Trauma Specific Frailty Index (TSFI)

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The impact of frailty on failure-to-rescue in geriatric trauma patients : A prospective study. / Joseph, Bellal; Phelan, Herb; Hassan, Ahmed; Orouji Jokar, Tahereh; OKeeffe, Terence; Azim, Asad; Gries, Lynn; Kulvatunyou, Narong; Latifi, Rifat; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 81, No. 6, 01.12.2016, p. 1150-1155.

Research output: Contribution to journalArticle

Joseph, B, Phelan, H, Hassan, A, Orouji Jokar, T, OKeeffe, T, Azim, A, Gries, L, Kulvatunyou, N, Latifi, R & Rhee, P 2016, 'The impact of frailty on failure-to-rescue in geriatric trauma patients: A prospective study', Journal of Trauma and Acute Care Surgery, vol. 81, no. 6, pp. 1150-1155. https://doi.org/10.1097/TA.0000000000001250
Joseph, Bellal ; Phelan, Herb ; Hassan, Ahmed ; Orouji Jokar, Tahereh ; OKeeffe, Terence ; Azim, Asad ; Gries, Lynn ; Kulvatunyou, Narong ; Latifi, Rifat ; Rhee, Peter. / The impact of frailty on failure-to-rescue in geriatric trauma patients : A prospective study. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 81, No. 6. pp. 1150-1155.
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abstract = "INTRODUCTION Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients. METHODS We performed a prospective cohort study of all elderly (age ≥ 65 years) trauma patients presenting at our level one trauma center. Patient's frailty status was calculated utilizing the Trauma Specific Frailty Index (TSFI) within 24 hours of admission. Patients were stratified into non-frail, pre-frail, and frail. FTR was defined as death from a major complication (respiratory, infectious, cardiac, and renal). Binary logistic regression analysis was performed after adjusting for age, gender, injury severity (ISS), and vital parameters to assess the relationship between frailty status and FTR. RESULTS A total of 368 elderly trauma patients were evaluated of which 25{\%} (n = 93) were non-frail, 38{\%} (n = 139) pre-frail, and 37{\%} (n = 136) frail. Overall, 30{\%} of the patients developed in-hospital complications; of them, mortality occurred in 26{\%} of the patients (FTR group). In the FTR group, 69{\%} of the patients were frail compared to 17{\%} pre-frail and 14{\%} non-frail (p = 0.002). On multivariate regression analysis for predictors of FTR, frail status was an independent predictor of FTR (OR [95{\%} CI] = 2.67 [1.37-5.20]; p = 0.004). On sensitivity analysis, positive predictive value of TSFI for FTR was 69{\%} and negative predictive value for FTR was 67{\%}. CONCLUSION In elderly trauma patients, the presence of frailty increased the odds of FTR almost threefold as compared to non-frail. Although FTR has been considered as an indicator of health care quality, the findings of this study suggest that frailty status independently contributes to FTR. This needs to be considered in the future development of quality metrics, particularly in the case of geriatric trauma patients.",
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AU - Joseph, Bellal

AU - Phelan, Herb

AU - Hassan, Ahmed

AU - Orouji Jokar, Tahereh

AU - OKeeffe, Terence

AU - Azim, Asad

AU - Gries, Lynn

AU - Kulvatunyou, Narong

AU - Latifi, Rifat

AU - Rhee, Peter

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N2 - INTRODUCTION Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients. METHODS We performed a prospective cohort study of all elderly (age ≥ 65 years) trauma patients presenting at our level one trauma center. Patient's frailty status was calculated utilizing the Trauma Specific Frailty Index (TSFI) within 24 hours of admission. Patients were stratified into non-frail, pre-frail, and frail. FTR was defined as death from a major complication (respiratory, infectious, cardiac, and renal). Binary logistic regression analysis was performed after adjusting for age, gender, injury severity (ISS), and vital parameters to assess the relationship between frailty status and FTR. RESULTS A total of 368 elderly trauma patients were evaluated of which 25% (n = 93) were non-frail, 38% (n = 139) pre-frail, and 37% (n = 136) frail. Overall, 30% of the patients developed in-hospital complications; of them, mortality occurred in 26% of the patients (FTR group). In the FTR group, 69% of the patients were frail compared to 17% pre-frail and 14% non-frail (p = 0.002). On multivariate regression analysis for predictors of FTR, frail status was an independent predictor of FTR (OR [95% CI] = 2.67 [1.37-5.20]; p = 0.004). On sensitivity analysis, positive predictive value of TSFI for FTR was 69% and negative predictive value for FTR was 67%. CONCLUSION In elderly trauma patients, the presence of frailty increased the odds of FTR almost threefold as compared to non-frail. Although FTR has been considered as an indicator of health care quality, the findings of this study suggest that frailty status independently contributes to FTR. This needs to be considered in the future development of quality metrics, particularly in the case of geriatric trauma patients.

AB - INTRODUCTION Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients. METHODS We performed a prospective cohort study of all elderly (age ≥ 65 years) trauma patients presenting at our level one trauma center. Patient's frailty status was calculated utilizing the Trauma Specific Frailty Index (TSFI) within 24 hours of admission. Patients were stratified into non-frail, pre-frail, and frail. FTR was defined as death from a major complication (respiratory, infectious, cardiac, and renal). Binary logistic regression analysis was performed after adjusting for age, gender, injury severity (ISS), and vital parameters to assess the relationship between frailty status and FTR. RESULTS A total of 368 elderly trauma patients were evaluated of which 25% (n = 93) were non-frail, 38% (n = 139) pre-frail, and 37% (n = 136) frail. Overall, 30% of the patients developed in-hospital complications; of them, mortality occurred in 26% of the patients (FTR group). In the FTR group, 69% of the patients were frail compared to 17% pre-frail and 14% non-frail (p = 0.002). On multivariate regression analysis for predictors of FTR, frail status was an independent predictor of FTR (OR [95% CI] = 2.67 [1.37-5.20]; p = 0.004). On sensitivity analysis, positive predictive value of TSFI for FTR was 69% and negative predictive value for FTR was 67%. CONCLUSION In elderly trauma patients, the presence of frailty increased the odds of FTR almost threefold as compared to non-frail. Although FTR has been considered as an indicator of health care quality, the findings of this study suggest that frailty status independently contributes to FTR. This needs to be considered in the future development of quality metrics, particularly in the case of geriatric trauma patients.

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