Trauma-Specific Frailty Index Research Articles

Reliability and validity of the Chinese version of the trauma-specific frailty index (TSFI) for geriatric trauma patients

BackgroundPre-traumatic frailty in geriatric trauma patients has caught attention from emergency medical workers and the assessment of it thus become one of the important aspects of risk management. Several tools are available to identify frailty, but limited tools have been validated for geriatric trauma patients in China to assess pre-traumatic frailty.The aim of this study is to translate the Trauma-Specific Frailty Index(TSFI) into Chinese, and to evaluate the reliability and validity of the translated version in geriatric trauma patients.MethodsA cross-sectional study was conducted. The TSFI was translated with using the Brislin model, that included forward and backward translation. A total of 184 geriatric trauma patients were recruited by a convenience sampling between October and December 2020 in Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan. Using reliability or internal consistency tests assessed with Cronbach’s alpha coefficient, split-half reliability and test-retest reliability. Content validity and construct validity analysis were both performed. Sensitivity, specificity and maximum Youden index(YI) were used to determine the optimal cut-off value. The screening performance was examined by Kappa value.ResultsThe total study population included 184 subjects, of which 8 participants were excluded, resulting in a study sample size of 176 elderly trauma patients (the completion rate was 95.7%). The Chinese version of Trauma-Specific Frailty Index(C-TSFI) have 15 items with 5 dimensions. Cronbach’s alpha coefficient of the C-TSFI was 0.861, Cronbach’s alpha coefficient of dimensions ranged from 0.837 to 0.875, the split-half reliability of the C-TSFI were 0.894 and 0.880 respectively, test-retest reliability ranged from 0.692 to 0.862. The correlation coefficient between items and the C-TSFI ranged from 0.439 to 0.761. The content validity index for items (I-CVI) of the C-TSFI scale was 0.86~1.00, and the scale of content validity index (S-CVI) was 0.93. The area under curve (AUC) of the C-TSFI was 0.932 (95%CI 0.904–0.96, P < 0.05), the maximum YI was 0.725, the sensitivity was 80.2%, the specificity was 92.3%, and the critical value was 0.31. Kappa value was 0.682 (P < 0.05).ConclusionsThe Chinese version of TSFI could be used as a general assessment tool in geriatric trauma patients, and both its reliability and validity have been demonstrated.

Relationship Between Frailty and Poor Prognosis in Older Trauma Patients in the Emergency Department: A Prospective Cohort Study

To explore the relationship between frailty and adverse outcomes in older trauma patients in the emergency department. A prospective cohort study was conducted. Older trauma patients admitted to the emergency department of three tertiary-care hospitals in Chengdu between January 2021 and August 2021 were enrolled. The patients were divided into a frailty group and a non-frailty group according to their assessment results for Trauma-Specific Frailty Index (TSFI). The end points, including falls, readmission, and deaths, were documented during the 6-month follow-up. Cox risk regression model was used to analyze the relationship between frailty and adverse outcomes in older trauma patients in the emergency department. A total of 375 older trauma patients in the emergency department were enrolled, including 131 in the frailty group and 244 in the non-frailty group. After 6 months of follow-up, the incidences of falls, readmission and deaths in older trauma patients in the emergency department were 18.93%, 14.40%, and 7.73%, respectively. The incidences of falls (28.24% vs. 13.93%, P=0.001), readmission (25.95% vs. 8.20%, P=0.000), and deaths (12.98% vs. 4.92%, P=0.005) in older trauma patients in the emergency department in the frailty group were higher than those in the non-frailty group. After adjusting for multiple confounding factors using the Cox regression model, the risks of falls (hazard ratio [ HR]=1.859, 95% confidence interval [ CI]: 1.070-3.230, P=0.028] and readmission ( HR=2.920, 95% CI: 1.537-5.547, P=0.001) were higher in the frailty group than those in the non-frailty group, but there was no significant difference in the risk of deaths between the frailty group and the non-frailty group. Frailty is a risk factor for falls and readmissions in older trauma patients in the emergency department and the association between frailty and the risk of deaths in older trauma patients in the emergency department needs to be validated by further studies.

Overview of Geriatric Trauma in an Urban Trauma Center in Eastern China: Implications from Computational Intelligence for Localized Trauma-Specific Frailty Index System Design

Due to the lifestyle and activity of the aging population, it is expected that geriatric trauma will increase and become one of the major challenges in health care. The objective of this study was to determine epidemiological differences between geriatric trauma patients and their younger counterparts, and to find the implications for localized Trauma-Specific Frailty Index (TSFI) system design. This study was a retrospective analysis of adult patients registered in the Trauma Registry, comparisons were made between the geriatric patients, aged over 65 years old, and the younger patients, aged 18–64 years old. Variables were collected include demography, injury mechanism, type, severity of injuries sustained, and outcomes. From July 2018 to July 2021, 2594 trauma patients were evaluated. Injury severity score (ISS) in the geriatric patients’ group is not higher than the younger patients’ group statistically (P = 0.066), and results in increased ICU occupancy and mortality risk as compared with the younger patients (P < 0.05). The majority of geriatric patients suffered falls from low heights and traffic accidents. The geriatric patients most suffered isolated injuries of the extremities/pelvis (31.8%) commonly. In contrast to the younger patients, they had more injuries of the head/neck or polytrauma (P < 0.05). This study provided a snapshot of the trauma burden in a proportion of the urban geriatric patients in Eastern China. The geriatric patients are unlike their younger counterparts, and their unique features should be considered in the future development of computational intelligence, particularly in the case of localized TSFI system design.

Decreased readmission rates following use of modified trauma-specific frailty index in older trauma patients: A follow-up study

IntroductionPost-discharge readmission rates using modified Trauma-Specific Frailty Index (mTSFI) compared to the Emergency Severity Index (ESI) are unknown. In our pilot study, we demonstrated that mTSFI usage more accurately triages older trauma patients. In the current study, we hypothesized that adult trauma patients triaged using mTSFI would have lower readmission rates at the 30-day interval post discharge. MethodsRetrospective review of readmission rates for 96 trauma patients ≥ 50 years old was performed. The two study groups were categorized as mTSFI-concordant and ESI-concordant. Fisher's exact test was performed. ResultsMean ages for ESI and mTSFI groups were 63.8 (SD 10.6) and 65.2 (SD 10.8) years. The 30-day readmission rate was 0% (0/32) in the mTSFI group vs 11% (7/64) in the ESI group (p = 0.104). ConclusionsUtilization of mTSFI for adult trauma patients may lead to lower 30-day readmission rates compared to using ESI, despite our sample sizes being too small to demonstrate a statistically significant difference.

Evaluation of the trauma-specific frailty index in geriatric trauma patients according to the new World Health Organization age classification.

We compared the 15-variable trauma-specific frailty index and traditional injury scoring systems to determine trauma severity and predict discharge disposition in geriatric trauma patients based on the old and new World Health Organization age classifications. This prospective, observational, single-center study included geriatric patients aged ≥65 years with blunt trauma. We categorized patients as elderly based on the old or new World Health Organization age classification into group I (aged 65-79 years) and group II (aged ≥a80 years), respectively. At admission, we used traditional injury scoring systems (e.g., the Glasgow coma scale, injury severity score, and revised trauma score) to determine trauma severity. We compared the Trauma-Specific Frailty Index and traditional injury scoring systems between the patient groups and evaluated them for correlations. We included 169 geriatric patients (80 and 89 in groups I and II, respectively). The mean Trauma-Specific Frailty Index score was significantly higher among females than males (p=0.025) and group II than group I (p=0.021). No significant correlations were observed in terms of the Trauma-Specific Frailty Index and traditional injury scoring systems in both groups. The mean Trauma-Specific Frailty Index score was significantly different between the hospitalized and discharged patients in group I (p=0.005), but not in group II (p=0.526). The 15-variable Trauma-Specific Frailty Index score is superior to traditional injury scoring systems for managing and predicting discharge disposition in geriatric trauma patients aged 65-79 years.

1080 NURSES’ PREFERENCE FOR TOOLS TO IDENTIFY FRAILTY IN MAJOR TRAUMA PATIENTS: FINDINGS FROM THE FRAIL-T IN MAJOR TRAUMA STUDY

Abstract Introduction Early assessment of frailty in older major trauma patients is important to providing appropriate care that goes beyond chronological age. Guidance exists that this assessment should be completed as early as possible in the Emergency Department (ED). To increase rates of frailty screening in this group the measurement tool needs to be quick to complete and easy to use. This study aimed to ascertain the preference of nursing staff completing frailty assessment in older major trauma patients in the ED. Method This prospective multi-centre study recruited from five UK MTCs between June 2019 and March 2020. Eligible patients were aged 65 or over requiring ‘trauma team activation’ and admitted to hospital. Patients were assessed for frailty by nurses trained to use three different frailty screening tools—the Clinical Frailty Scale (CFS), the PRISMA-7 tool, and the Trauma Specific Frailty Index (TSFI). Completion rates for each of the tools were calculated and nurses were asked to rate their preference for each of the tools and the reasons for non-completion if relevant. Results Data were analysed from 370 patients. Completion rates for each of the tools varied with highest degree of compliance using the CFS (98.9%). TSFI was least likely to be completed with ‘lack of available information to complete questions’ as the most cited reason. Nurses showed a clear preference for the CFS with 57.3% ranking this as first choice (PRISMA-7 32.16%; TSFI 10.54%). Both PRISMA-7 and CFS were both rated highly as ‘extremely easy to complete’ (PRISMA-7 58.5%, CFS 59.61%). Conclusion User acceptability is an important consideration in the selection of a frailty measurement tool for use in major trauma patients. Our study shows the Clinical Frailty Scale has high rates of completion and acceptability and can be implemented in practice for assessment of frailty in major trauma.

A Comparative Analysis of Hospital Triage Systems in the Geriatric Adult Trauma Patients: A Quality Improvement Pilot Study.

The objective of our study is to compare the predicted hospital admission disposition based on the level of risk as determined by the modified Trauma-Specific Frailty Index (mTSFI) score with those determined by arbitrary decisions made based on the Emergency Severity Index (ESI) severity level. We surveyed 100 trauma patients ages 50 and older, admitted to a level 1 trauma center between April 2019 and July 2019. We retrospectively reviewed the hospital admission disposition of each patient under the ESI, which was then compared to the mTSFI-predicted hospital admission disposition. The mTSFI scores were calculated by surveying each patient. Statistical analysis was performed to identify any statistical significance of concordance and discordance when comparing the mTSFI and ESI. The average age was 57.6 ± 4.2 years old in the non-geriatric group vs 76.3 ± 7.3 years old in the geriatric group. There was a male predominance in both groups (61% vs 69.5%). The mTSFI identified a higher percentage of triage discordance in the non-geriatric group (73%) compared to the geriatric cohort (53%) (95% difference CI, [39.6-40], P = .05). Non-geriatric patients have higher recorded rate of frailty than previously recognized and screening should begin at age 50, not 65. The mTSFI may be an effective tool to appropriately triage adult trauma patients at increased risk due to frailty and may reduce in-hospital complications.

Validating the agreement between the geriatric trauma frailty index and four published frailty scores in the Chinese geriatric trauma population

BackgroundIn the geriatric patient population, frailty significantly affects a patient’s prognostic outcome. This study aimed to compare the consistency of our constructed geriatric trauma frailty index with previously published indexes.MethodsThe geriatric trauma frailty index (GTFI) was compared with four previously published frailty indexes, i.e., the hospital frailty risk score (HFRS), Fried index, trauma-specific frailty index (TSFI), and 11-item modified frailty index (mFI) using the Bland-Altman method, intraclass correlation coefficient (ICC), and kappa consistency test. The indexes were calculated based on data collected from 101 questionnaires and medical records from 101 geriatric trauma patients at a tertiary hospital in Shanghai.ResultsAmong the 101 geriatric trauma patients, 64 (63.4%) were women, with a mean age of 71.18 (SD = 9.89) years and mean length of stay (LOS) of 7.51 (SD = 3.89) days. The mean scores of GTFI score(≥ 1.3045 as frail), Fried index score(≥3 items as frail), TSFI score(≥ 4 as frail), and mFI (≥ 3 as frail),were 0.86 (SD = 1.51), 0.76 (SD = 1.07), 1.76 (SD = 1.96), and 1.29 (SD = 1.17). respectively. The GTFI score had good consistency with the HFRS (ICC: 0.716, 95% confidence interval [CI]: 0.596, 0.799, kappa: 0.608, 95% CI: 0.449, 0.766), fair consistency with the TSFI (ICC: 0.407, 95% CI: 0.227, 0.562, kappa: 0.460, 95% CI: 0.239, 0.672), and poor consistency with the mFI (ICC: 0.286, 95% CI: 0.097, 0.455, kappa: 0.305, 95% CI: 0.069, 0.525) and Fried index score (ICC: 0.256, 95% CI: 0.063, 0.426, kappa: 0.188, 95% CI: − 0.028, 0.408).ConclusionsDifferent frailty indexes are based on different concepts of frailty and cannot be assumed to be interchangeable. There is still no gold standard for the current assessment methods of frailty, but it can be compared based on the understanding in terms of the concepts and measures used in each.

Feasibility and accuracy of ED frailty identification in older trauma patients: a prospective multi-centre study

BackgroundThe burden of frailty on older people is identifiable by its adverse effect on mortality, morbidity and long term functional and health outcomes. In patients suffering from a traumatic injury there is increasing evidence that it is frailty rather than age that impacts greatest on these outcomes and that early identification can guide frailty specific care. The aim of this study was to evaluate the feasibility of nurse-led assessment of frailty in older trauma patients in the ED in patients admitted to major trauma centres.MethodsPatients age 65 years and over attending the Emergency Departments (ED) of five Major Trauma Centres following traumatic injury were enrolled between June 2019 and March 2020. Patients were assessed for frailty whilst in the ED using three different screening tools (Clinical Frailty Scale [CFS], Program of Research to Integrate Services for the Maintenance of Autonomy 7 [PRIMSA7], and the Trauma Specific Frailty Index [TSFI]) to compare feasibility and accuracy. Accuracy was determined by agreement with geriatrician assessment of frailty. The primary outcome was identification of frailty in the ED using three different assessment tools.ResultsWe included 372 patients whose median age was 80, 53.8% of whom were female. The most common mechanism of injury was fall from less than 2 m followed by falls greater than 2 m. Completion rates for the tools were variable, 31.9% for TSFI, compared to 93% with PRISMA7 and 98.9% with the CFS. There was substantial agreement when using CFS between nurse defined frailty and geriatrician defined frailty. Agreement was moderate using PRISMA7 and slight using TSFI.ConclusionsThis prospective study has demonstrated that screening for frailty in older major trauma patients within the Emergency Department is feasible and accurate using CFS.Trial registrationISRCTN, ISRCTN10671514. Registered 22 October 2019

Association of Patient Reported Global Health Measures with Frailty Scores in Acutely Injured Older Adults.

The older population is particularly vulnerable to traumatic injury. Frailty scores, used to estimate the physiologic status of an individual, are key to identifying those most at risk for injury. Global health measures such as the Veterans RAND 12 Item Health Survey (VR-12) are quality of life measures that assess older adults' overall perception of their health and may serve as a useful adjunct when predicting frailty. Herein, we evaluated whether components of the VR-12 correlated with worse frailty scores over time. Older adults (≥65) admitted to burn, trauma, or emergency general surgery services were prospectively enrolled. Demographics, frailty determined using the Trauma Specific Frailty Index (TSFI), and VR-12 surveys were collected at enrollment and 3, 6, 9, and 12-month follow-ups. A physical component score (PCS) and mental component score (MCS) was produced by VR-12 surveys for comparison purposes. Fifty-eight patients were enrolled, of which 8 died. No significant changes in PCS (p = 0.25) and MCS (p = 0.56) were observed over time. PCS (p = 0.97) and MCS (p = 0.78) at enrollment did not predict mortality. PCS (OR = 0.894 [0.84-0.95], p = 0.0004) and age (OR = 1.113 [1.012-1.223], p = 0.03) independently predicted enrollment frailty. These global measures of health could be utilized in lieu or in addition to frailty scores when assessing patients in the setting of acute injury. Studies are warranted to confirm this association.

Evaluating the Use of the Trauma-Specific Frailty Index in Older Patients with Hip Fractures

Evaluating the Use of the Trauma-Specific Frailty Index in Older Patients with Hip Fractures

A Prospective Comparison of Frailty Scores and Fall Prediction in Acutely Injured Older Adults

BackgroundElderly (65 and older) fall-related injuries are a significant cause of morbidity and mortality. Although frailty predicts poor outcomes in geriatric trauma, literature comparing frailty scoring systems remains limited. Herein, we evaluated which frailty scoring system best predicts falls over time in the elderly. Materials and methodsAcute surgical patients 65 y and older were enrolled and prospectively observed. Demographics and frailty, assessed using the FRAIL Scale, Trauma Specific Frailty Index (TSFI), and Canadian Frailty Scale (CSHA-CFS), were collected at enrollment and 3 mo intervals following discharge for 1 y. Surveys queried the total number and timing of falls. Changes in frailty over time were assessed by logistic regression and area under the curve (AUC). ResultsFifty-eight patients were enrolled. FRAIL Scale and CSHA-CFS scores did not change over time, but TSFI scores did (P ≤ 0.01). Worsening frailty was observed using TSFI at 6 (P ≤ 0.01) and 12 mo (P ≤ 0.01) relative to baseline. Mortality did not differ based on frailty using any frailty score. Increasing frailty scores and time postdischarge was associated with increased odds of a fall. AUC estimates with 95% CI were 0.72 [0.64, 0.80], 0.81 [0.74, 0.88], and 0.76 [0.68, 0.84] for the FRAIL Scale, TSFI, and CSHA-CFS, respectively. ConclusionsThe risk of falls postdischarge were associated with increased age, time postdischarge, and frailty in our population. No scale appeared to significantly outperform the other by AUC estimation. Further study on the longitudinal effects of frailty is warranted.

Prospective evaluation of health-related quality of life in geriatric trauma patients

BackgroundFrailty is an established predictor of adverse outcomes in geriatric patients. Health-related quality of life (HRQoL) is an important outcome measure among trauma patients. This prospective observational study examined the impact of frailty on health-related quality of life in geriatric trauma patients. MethodsWe prospectively enrolled geriatric (age ≥65 years) trauma patients. We calculated the frailty index (FI) within 24 hours of admission using the trauma-specific frailty index. Patients were stratified into frail (frailty index ≥0.27) and nonfrail (frailty index <0.27). Health-related quality of life was calculated at discharge and at 30 days (day) after discharge using the RAND Short Form-36 (SF-36). Outcome measures were health-related quality of life at discharge, 30-days postdischarge, and delta health-related quality of life. Regression analysis was performed to control for demographic, vital signs, and injury parameters. ResultsWe enrolled 296 patients. The mean age was 75.1 ± 9.8 years, 59% were male, and 81% were white. Frail patients accounted for 34%, and they had a lower health-related quality of life at discharge (366 vs 548, P < .01) and at 30-day postdischarge (393 vs 744, P < .01). Nonfrail patients scored higher in 6 out of 8 domains of health-related quality of life. Nonfrail patients had improved delta health-related quality of life (P < .01), unlike frail patients (P = .11). A linear regression model revealed an inverse relationship between frailty and improvement in health-related quality of life over 30-day postdischarge (β = –0.689, [confidence interval, –0.963 to –0.329] P = .01). This association remained statistically significant after controlling for potential confounding covariates, such as age, sex, race, and injury severity. ConclusionCompared with nonfrail geriatric trauma patients, those who were frail had poor health-related quality of life at discharge and at 30-day postdischarge. Frailty negatively affects the recovery of health-related quality of life after trauma. The use of frailty indices may help identify and develop targeted interventions to improve health-related quality of life among geriatric trauma patients.

The acute inflammatory response after trauma is heightened by frailty: A prospective evaluation of inflammatory and endocrine system alterations in frailty.

Frailty is a geriatric syndrome characterized by decreased physiological reserves, increased inflammation, and decreased anabolic-endocrine response. The biomarkers associated with frailty are poorly understood in trauma. The aim of this study was to analyze the association between frailty and immune: IL-1β, IL-6, IL-2Rα, tumor necrosis factor (TNF)-α, and endocrine biomarkers: insulin-like growth factor-1 and growth hormone in trauma patients. We conducted a 1-year (2017-2018) prospective analysis of geriatric (≥65 years) trauma patients admitted to our Level I trauma center. Frailty was measured using the trauma-specific frailty index (TSFI) and blood samples were collected within 24 hours of admission. Patients were stratified into two groups: frail (TSFI > 0.25) and nonfrail (TSFI ≤ 0.25). We then measured the levels of immune and endocrine biomarkers by a colorimetric output that was read by a spectrophotometer (Quantikine ELISA). The outcome measures were the levels of the immune and endocrine markers in the two groups. Multivariable linear regression was performed. A total of 100 geriatric trauma patients were consented and enrolled. The mean age was 77.1 ± 9.8 years and 34% were female. Thirty-nine (39%) patients were frail. Frail patients were more likely to present after falls (p = 0.01). There was no difference in age (p = 0.78), sex (p = 0.77), systolic blood pressure (p = 0.16), and heart rate (p = 0.24) between the two groups. Frail patients had higher levels of TNF-α (p = 0.01), IL-1β (p = 0.01), and IL-6(p = 0.01) but lower levels of growth hormone (p = 0.03) and insulin-like growth factor-1 (p < 0.04) compared with nonfrail patients. There was no difference in the level of IL-2Rα (p = 0.25). On regression analysis, frailty was positively correlated with the levels of proinflammatory biomarkers, that is, TNF- α, IL-1 β, and IL-6 and negatively correlated with endocrine biomarkers. This study supports the association between frailty and immune and endocrine markers. Frailty acts synergistically with trauma in increasing the acute inflammatory response. Moreover, frail patients have lower levels of anabolic hormones. Understanding the inflammatory and endocrine response in frail trauma patients may result in better therapeutic strategies.

Prospective evaluation of frailty and functional independence in older adult trauma patients

BackgroundThe aim of our study was to assess the association between frailty and functional status in geriatric trauma patients. Methods3-year(2013–2015) prospective analysis and included all geriatric trauma patients(≥65y) discharged to a single rehabilitation center from our level-I trauma center. Frailty was measured using Trauma-Specific-Frailty-Index(TSFI) while Functional status was assessed using functional-independence-measure(FIM) at admission and discharge from rehabilitation center. Multivariate linear regression analysis was performed. Results267 patients were enrolled. Mean age was 76.9 ± 7.1y, 63.6% were males. Overall, 22.8% were frail, and 37.4% were pre-frail. On linear regression, higher motor-FIM, higher cognitive-FIM scores at admission, and longer length-of-stay at rehab were independently associated with increased discharge FIM score. While, ISS(injury-severity-score), pre-frail and frail status were negatively correlated with FIM gain. ConclusionFrail patients were less likely to recover to their baseline functional status compared with non-frail patients. Early focused intervention in frail elderly patients is warranted to improve functional status in this population.

Sarcopenia defined by a computed tomography estimate of the psoas muscle area does not predict frailty in geriatric trauma patients

IntroductionThe aim of our study was to assess the correlation between frailty & sarcopenia and impact of each condition on outcomes in geriatric trauma patients. MethodsWe performed a four-year (2013–2016) secondary analysis of our prospectively maintained frailty database and included all trauma patients age ≥65 y who had CT-abdomen. Trauma-Specific-Frailty-Index (TSFI) was used to calculate frailty. Patients were classified as non-frail or frail. Sarcopenia was defined as the lowest sex-specific-quartile of total-psoas-index (TPI). Outcome measures included in-hospital complications, mortality and adverse disposition. Results325 patients were included in the study, 36% (n = 117) were frail and 24.9% (n = 81) had sarcopenia. There was a weak correlation between frailty and sarcopenia (R2 = 0.04). The overall rate of complications and mortality was 19.4% and 7.7% respectively. On regression analysis, after controlling for possible confounding variables and frailty status, sarcopenia was associated with adverse disposition (OR:1.41,p = 0.01). However, it was not associated with in-hospital complications (OR:1.21,p = 0.54) or in-hospital mortality (OR:1.12,p = 0.73). ConclusionSarcopenia as an individual marker might not be an effective screening tool for risk assessment in geriatric-trauma patients. Frailty assessment should be a part of risk assessment and prognostication.

OPTIMIZED UPPER EXTREMITY FRAILTY PARAMETERS FOR ASSESSING FRAILTY IN TRAUMA PATIENTS

Recently, an innovative upper extremity frailty (UEF) meter was developed and validated based on two inertial wearable sensors and combination of sensor-derived kinematics/kinetics and patient’s demographics including age, height and body mass. This study presents an optimized model to predict frailty status based on a single wearable sensor and without demographic/anthropometrics information. A dataset of 100 trauma patients (49 frail and 51 nonfrail) were retrospectively analyzed in which two inertial sensors were attached to elbow and forearm to quantify motor performance during a 20-second repetitive elbow flexion-extension task. The test protocol included performing elbow flexion/extension as fast as possible in supine position for 20-second. The classification accuracy of new algorithm was compared with previous method as well as Trauma-Specific Frailty Index as gold standard. We extracted totally 34 UEF sensor-derived parameters indicators of slowness, exhaustion, flexibility, and weakness. A multivariate linear regression model was used to identify independent predictors. Bootstrap technique was employed for generating training and validation dataset randomly with 1000 iterations. ANOVA statistic and recursive feature elimination technique were used for reducing and optimizing the UEF parameters. After training the model, 5 independent parameters were selected. Using the model, sensitivity of 85.3%, specificity of 78.5% and accuracy of 81.6% were achieved in the validation dataset. While new results were comparable with previous method, it allows identifying frailty using a single sensor and independent of subject’s demographic/anthropometrics information and thus making it a more practical tool for busy clinics without the need of specific training or additional measurements.

Redefining the association between old age and poor outcomes after trauma: The impact of frailty syndrome.

Frailty syndrome (FS) is a well-established predictor of outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and to determine its association with trauma readmissions, repeat falls, and mortality at 6 months. we performed a 2-year (2012-2013) prospective cohort analysis of all consecutive geriatric (age, ≥ 65 years) trauma patients. FS was assessed using a Trauma-Specific Frailty Index (TSFI). Patients were stratified into: nonfrail, TSFI ≤ 0.12; prefrail, TSFI = 0.1 to 0.27; and frail, TSFI > 0.27. Patient follow-up occurred at 6 months to assess outcomes. Regression analysis was performed to assess independent associations between TSFI and outcomes. Three hundred fifty patients were enrolled. Frail patients were more likely to develop in-hospital complications (nonfrail, 12%; prefrail, 17.4%; and frail, 33.4%; p = 0.02) and an adverse discharge disposition compared with nonfrail and prefrail (nonfrail, 8%; prefrail,18%; and frail, 47%; p = 0.001). Six-month follow-up was recorded in 80% of the patients. Compared with nonfrail patients, frail patients were more likely to have had a trauma-related readmission (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-3.6) and/or repeated falls (OR, 1.6; 95%CI, 1.1-2.5) over the 6-month period. Overall 6-month mortality was 2.8% (n = 10), and frail elderly patients were more likely to have died (OR, 1.1; 95% CI, 1.04-4.7) compared with nonfrail patients. Over a third of geriatric trauma patients had FS. TSFI provides a practical and accurate assessment tool for identifying elderly trauma patients who are at increased risk of both short-term and long-term outcomes. Early focused intervention in frail geriatric patients is warranted to improve long-term outcomes. Prognostic study, level II.

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

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. 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. 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%. 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. Prognostic study, level II.

Assessing Upper-Extremity Motion: An Innovative, Objective Method to Identify Frailty in Older Bed-Bound Trauma Patients

Despite increasing evidence that assessing frailty facilitates medical decision-making, a quick and clinically simple frailty assessment tool is not available for trauma settings. This study examined accuracy and acceptability of a novel wearable technology (upper-extremityfrailty [UEF]) to objectively assess frailty status in older adults (65 years or older) admitted to the hospital due to traumatic ground-level falls. Frailty was measured using a validated modified Rockwood questionnaire, the Trauma-Specific Frailty Index (TSFI), as the gold standard. Participants performed a 20-second trial of rapid elbow flexion with the dominant elbow in a supine posture while wearing the UEF system. We recruited 101 eligible older adults (age 79 ± 9 years). Parameters of the UEF indicative of slowness, weakness, and exhaustion during elbow flexion were independent predictors of the TSFI score, while adjusted for age, sex, and body mass index. A high agreement (r= 0.72, p< 0.0001) was observed between TSFI score and the UEF model; sensitivity and specificity for predicting the frailty status were 78% and 82%, respectively. Of recruited participants, 57% were not able to walk at the time of measurements, suggesting a limitation for walking-based frailty assessments. Significant correlations were observed between UEF parameters and number of falls within a previous year, with highest correlation observed for elbow flexion slowness (r=-0.41). The results suggest that a simple test of 20-second elbow flexion may be practical and sensitive to identify frailty among hospitalized older adults. The UEF test is independent of walking assessments, reflects several frailty markers, and it is practical for bed-bound patients.