1593 FRAILTY AND OUTCOMES FOR OLDER PATIENTS TREATED IN A MAJOR TRAUMA CENTRE

Abstract

Abstract Introduction Older people are the fastest growing group of hospitalised trauma patients, most commonly due to falls from standing height. The Scottish Trauma Audit Group (STAG) collect extensive national data, but this does not currently include frailty and longer-term dependency. Method We retrospectively reviewed consecutive cases in the STAG database for the Royal Infirmary of Edinburgh between September 2018 and February 2019. Casenote review was used to calculate baseline Charleston Comorbidity Index (CCI) and frailty status using the Clinical Frailty Scale (CFS). Outcomes of residence and mortality were collected to 1 year. Results We included 442 patients (mean age 62±20 years old, 43% female), of whom 218 (49%) were ≥65 years old (mean 78±8 years, 57% female). CFS could be ascertained in 209 (96%) patients ≥65 years, of whom 73 (35%) were frail (CFS ≥5). Frail patients were older (82±8 years vs. 77±8 years, p<0.001) and had more comorbidities (mean CCI 5.4±1.8 vs. 4.4±1.8, p<0.001) prior to trauma compared to non-frail patients >65 years old. Median Injury Severity Scores (ISS) did not vary by age (9 [5-12] ≥65 years vs. 9 [8-16] <65 years, p=0.07) or frailty status (9 [9-10] frail vs 9 [4-14] non-frail, p=0.59). Frail older patients were twice as likely to die within one year of trauma (32% vs 14% in non-frail, p<0.001), and this was independent of age (adjusted odds ratio 2.4, 95% confidence intervals 1.2–4.9, p=0.02). In survivors to 1 year, 16% of frail older patients required increased care at home (vs. 8% of non-frail older patients, p<0.001) and 14% were newly admitted to a care home (vs. 4% of non-frail, p<0.001). Conclusion A third of older patients with trauma are frail and this is an important predictor of patient outcomes beyond death. Frailty provides more prognostic information than age in this setting.