Is frailty associated with poor in-hospital or longer term outcomes following trauma?
Sarah O’Rorke1, Claire Tipping1, Melissa Webb1, Lara Kimmel1,21Alfred Health, Victoria, Australia2Monash University, Victoria, Australia
Abstract
Introduction: Recent evidence suggests that frailty may be better than age itself to predict the outcomes following trauma. Frailty also leads to prolonged hospitalisation and increased burden on the hospital system. The aim of this study is to review the prevalence of frailty in our trauma cohort and the association of frailty with hospital based outcomes.
Methods: Patient demographics, discharge destination, hospital length of stay (LOS), and mortality were reviewed. Frailty was assessed using the Clinical Frailty Scale (score <4 non frailty, 4 vulnerable, ≥5 frail). Factors associated with frailty and outcomes including discharge destination (home or inpatient care) and LOS (p value <0.2) were included in multivariate models.
Results: 1699 patients were admitted to the trauma ward between November 2020-August 2021 with 293 (17%) being frail and 196 (11.5%) being vulnerable. In the group over 65 years, 37% were frail. When taking in account confounding factors (including age), being frail was associated with discharge to further inpatient care (AOR 3.6 95%CI 2.18-6.0 p value <0.001) as well as an increased LOS (p<0.001). By 12 months post injury, the mortality rate of frail patients was 28%, compared to 3% for the rest of the population.
Conclusion: After taking into account confounding factors, frailty is associated with an increased LOS and over three times the odds of a discharge to further inpatient care, thus further increasing the hospital costs. Identifying frailty on admission will help prioritise resources to limit burden on hospital systems and improve patient outcomes.
Biography
Lara is the Allied Health Team Leader for the trauma ward at The Alfred. She is passionate about improving patient flow, innovative models of care and the use of data to inform practice.