Frailty predicts adverse outcomes in older adults admitted with trauma

Dr Frances Rickard is an ST5 Geriatric Medicine trainee, and the trainee rep for the BGS Perioperative care of Older People undergoing Surgery (POPS) SIG. Dr Sarah Ibitoye is an ST6 Acute Internal Medicine trainee, with a specialist interest in Perioperative Medicine. Here they discuss the findings of their Age and Ageing paper 'The Clinical Frailty Scale predicts adverse outcome in older people admitted to a UK major trauma centre', which describes data collected during their Perioperative Medicine Fellowships at North Bristol NHS Trust. Follow them on twitter via @francesrick and @sarah_ibitoye.

Trauma is becoming a geriatric specialty, with the majority of major trauma admissions now adults over 65 years.  Injury severity in these older adults is comparable to that of younger patients, yet mortality is far higher.

Since April 2019 we have been carrying out comprehensive geriatric assessment (CGA) of all older adults admitted with trauma to our Major Trauma Centre, in response to amendments to the major trauma Best Practice Tariff (BPT). Despite this national initiative, there were no UK studies considering an association between the Clinical Frailty Scale (CFS) and outcomes in older trauma patients.

As anticipated, our data have shown that frailty is an independent predictor of 30-day mortality, with risk of death increasing with severity of frailty. Frailty is also associated with increased risk of inpatient delirium and increased care level at discharge.  

Importantly, adults with frailty suffering less severe injuries (Injury Severity Score (ISS) ≤ 15) have a similar risk of death to those who are not frail but sustained major trauma (ISS >15). However, the BPT-mandated geriatrician review does not apply to these less severely injured patients. 

Now we have confirmed that CFS can identify trauma patients at risk of poor outcomes, the next step is to examine the impact of intervention in this group. We know from work in the hip fracture cohort that CGA embedded into clinical practice improves outcomes. With continued local enthusiasm for geriatrician involvement in trauma care, our perioperative medicine service has expanded to provide CGA for all older adults admitted with trauma. We look forward to presenting our findings on the impact of this service in the future.

Nationally, we hope to see increasing collaboration between physicians and surgeons in caring for older adults admitted with trauma in recognition of the complexity of this patient group.

Read the Age and Ageing paper 'The Clinical Frailty Scale predicts adverse outcome in older people admitted to a UK major trauma centre' here: https://doi.org/10.1093/ageing/afaa180