The Effect of Frailty in Predicting Outcomes of Rib Fractures Among Elderly Patients
Introduction Rib fractures are consequential injuries for geriatric trauma patients. Frailty has been associated with adverse outcomes in this population. The Rib Fracture Frailty Index (RFF) and 5-factor modified Frailty Index (mFI) are 2 validated frailty metrics. Research assessing inclusion of f...
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| Veröffentlicht in: | The American surgeon 2024-08, Vol.90 (8), p.1994-1999 |
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| container_issue | 8 |
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| container_title | The American surgeon |
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| creator | Johnson, Emily H. Brockman, Valerie Schmoekel, Nathan Schroeppel, Thomas J. |
| description | Introduction
Rib fractures are consequential injuries for geriatric trauma patients. Frailty has been associated with adverse outcomes in this population. The Rib Fracture Frailty Index (RFF) and 5-factor modified Frailty Index (mFI) are 2 validated frailty metrics. Research assessing inclusion of frailty metrics in geriatric rib fractures triage protocols is limited.
Methods
A retrospective cohort study was performed for trauma patients ≥50 years old with rib fractures admitted to a Level I trauma center, which currently uses percent predicted forced vital capacity (FVC%) to triage rib fractures patients. Frailty metrics (RFF & mFI) were calculated retrospectively, stratifying patients as low, moderate, or severe frailty. Unfavorable discharge disposition (UDD) was defined as discharge to facility or death. Unadjusted and adjusted odds ratios were used to assess frailty with outcome variables.
Results
In total, 834 patients were included from August 2018 - May 2023, with mean age of 69.1. A majority had low frailty (64.0 vs 40.3%), followed by moderate frailty (21.1 vs 30.7%), then severe frailty (14.9 vs 29.0%) for RFF and mFI, respectively. Age, sex, and ISS differed between groups. For RFF, increased frailty was associated with longer hospital and ICU length of stay. Neither frailty metric was associated with unplanned ICU transfer or intubation. In the adjusted analysis, frail patients were more likely to have UDD (OR 8.9, CI 3.4-23.0, P < .0001).
Conclusion
While both frailty metrics were predictive of UDD, neither was associated with ICU transfer or intubation, suggesting that frailty does not enhance the accuracy of our current protocol using FVC%. |
| doi_str_mv | 10.1177/00031348241241704 |
| format | Article |
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Rib fractures are consequential injuries for geriatric trauma patients. Frailty has been associated with adverse outcomes in this population. The Rib Fracture Frailty Index (RFF) and 5-factor modified Frailty Index (mFI) are 2 validated frailty metrics. Research assessing inclusion of frailty metrics in geriatric rib fractures triage protocols is limited.
Methods
A retrospective cohort study was performed for trauma patients ≥50 years old with rib fractures admitted to a Level I trauma center, which currently uses percent predicted forced vital capacity (FVC%) to triage rib fractures patients. Frailty metrics (RFF & mFI) were calculated retrospectively, stratifying patients as low, moderate, or severe frailty. Unfavorable discharge disposition (UDD) was defined as discharge to facility or death. Unadjusted and adjusted odds ratios were used to assess frailty with outcome variables.
Results
In total, 834 patients were included from August 2018 - May 2023, with mean age of 69.1. A majority had low frailty (64.0 vs 40.3%), followed by moderate frailty (21.1 vs 30.7%), then severe frailty (14.9 vs 29.0%) for RFF and mFI, respectively. Age, sex, and ISS differed between groups. For RFF, increased frailty was associated with longer hospital and ICU length of stay. Neither frailty metric was associated with unplanned ICU transfer or intubation. In the adjusted analysis, frail patients were more likely to have UDD (OR 8.9, CI 3.4-23.0, P < .0001).
Conclusion
While both frailty metrics were predictive of UDD, neither was associated with ICU transfer or intubation, suggesting that frailty does not enhance the accuracy of our current protocol using FVC%.</description><identifier>ISSN: 0003-1348</identifier><identifier>ISSN: 1555-9823</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/00031348241241704</identifier><identifier>PMID: 38538583</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Age ; Aged ; Aged, 80 and over ; Chronic obstructive pulmonary disease ; Clinical medicine ; Clinical practice guidelines ; Emergency medical care ; Female ; Females ; Fractures ; Frail Elderly - statistics & numerical data ; Frailty ; Frailty - complications ; Frailty - diagnosis ; Gastroesophageal reflux ; Geriatric Assessment - methods ; Geriatrics ; Glasgow Coma Scale ; Humans ; Injury prevention ; Intensive care ; Intubation ; Length of stay ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; Mortality ; Patients ; Regression analysis ; Retrospective Studies ; Rib Fractures - complications ; Trauma ; Trauma Centers ; Triage</subject><ispartof>The American surgeon, 2024-08, Vol.90 (8), p.1994-1999</ispartof><rights>The Author(s) 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c320t-8c739a5bd91717877aef63158558d247641ce40fe005a56b4cc6df0d51563b183</cites><orcidid>0000-0003-2133-4950</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00031348241241704$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00031348241241704$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38538583$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Johnson, Emily H.</creatorcontrib><creatorcontrib>Brockman, Valerie</creatorcontrib><creatorcontrib>Schmoekel, Nathan</creatorcontrib><creatorcontrib>Schroeppel, Thomas J.</creatorcontrib><title>The Effect of Frailty in Predicting Outcomes of Rib Fractures Among Elderly Patients</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Introduction
Rib fractures are consequential injuries for geriatric trauma patients. Frailty has been associated with adverse outcomes in this population. The Rib Fracture Frailty Index (RFF) and 5-factor modified Frailty Index (mFI) are 2 validated frailty metrics. Research assessing inclusion of frailty metrics in geriatric rib fractures triage protocols is limited.
Methods
A retrospective cohort study was performed for trauma patients ≥50 years old with rib fractures admitted to a Level I trauma center, which currently uses percent predicted forced vital capacity (FVC%) to triage rib fractures patients. Frailty metrics (RFF & mFI) were calculated retrospectively, stratifying patients as low, moderate, or severe frailty. Unfavorable discharge disposition (UDD) was defined as discharge to facility or death. Unadjusted and adjusted odds ratios were used to assess frailty with outcome variables.
Results
In total, 834 patients were included from August 2018 - May 2023, with mean age of 69.1. A majority had low frailty (64.0 vs 40.3%), followed by moderate frailty (21.1 vs 30.7%), then severe frailty (14.9 vs 29.0%) for RFF and mFI, respectively. Age, sex, and ISS differed between groups. For RFF, increased frailty was associated with longer hospital and ICU length of stay. Neither frailty metric was associated with unplanned ICU transfer or intubation. In the adjusted analysis, frail patients were more likely to have UDD (OR 8.9, CI 3.4-23.0, P < .0001).
Conclusion
While both frailty metrics were predictive of UDD, neither was associated with ICU transfer or intubation, suggesting that frailty does not enhance the accuracy of our current protocol using FVC%.</description><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Clinical medicine</subject><subject>Clinical practice guidelines</subject><subject>Emergency medical care</subject><subject>Female</subject><subject>Females</subject><subject>Fractures</subject><subject>Frail Elderly - statistics & numerical data</subject><subject>Frailty</subject><subject>Frailty - complications</subject><subject>Frailty - diagnosis</subject><subject>Gastroesophageal reflux</subject><subject>Geriatric Assessment - methods</subject><subject>Geriatrics</subject><subject>Glasgow Coma Scale</subject><subject>Humans</subject><subject>Injury prevention</subject><subject>Intensive care</subject><subject>Intubation</subject><subject>Length of stay</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Rib Fractures - complications</subject><subject>Trauma</subject><subject>Trauma Centers</subject><subject>Triage</subject><issn>0003-1348</issn><issn>1555-9823</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE9LAzEQxYMotlY_gBdZ8OJla2aTbNJjKa0KhRap5yWbzdaU_VOT7KHf3iytCoowMEzeb16Sh9At4DEA548YYwKEioRCKI7pGRoCYyyeiISco2Gvxz0wQFfO7cJIUwaXaEAECyXIEG027zqal6VWPmrLaGGlqfwhMk20trowyptmG606r9pau554NXlPKd_ZcDCt26DPq0Lb6hCtpTe68e4aXZSycvrm1EfobTHfzJ7j5erpZTZdxook2MdCcTKRLC8mwIELzqUuUwJMMCaKhPKUgtIUlxpjJlmaU6XSosQFA5aSHAQZoYej7962H512PquNU7qqZKPbzmUEAw1_JmkS0Ptf6K7tbBNelxFIACaCCBooOFLKts5ZXWZ7a2ppDxngrI88-xN52Lk7OXd5rYvvja-MAzA-Ak5u9c-1_zt-Av0Ihb8</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Johnson, Emily H.</creator><creator>Brockman, Valerie</creator><creator>Schmoekel, Nathan</creator><creator>Schroeppel, Thomas J.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7T7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2133-4950</orcidid></search><sort><creationdate>202408</creationdate><title>The Effect of Frailty in Predicting Outcomes of Rib Fractures Among Elderly Patients</title><author>Johnson, Emily H. ; Brockman, Valerie ; Schmoekel, Nathan ; Schroeppel, Thomas J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c320t-8c739a5bd91717877aef63158558d247641ce40fe005a56b4cc6df0d51563b183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Clinical medicine</topic><topic>Clinical practice guidelines</topic><topic>Emergency medical care</topic><topic>Female</topic><topic>Females</topic><topic>Fractures</topic><topic>Frail Elderly - statistics & numerical data</topic><topic>Frailty</topic><topic>Frailty - complications</topic><topic>Frailty - diagnosis</topic><topic>Gastroesophageal reflux</topic><topic>Geriatric Assessment - methods</topic><topic>Geriatrics</topic><topic>Glasgow Coma Scale</topic><topic>Humans</topic><topic>Injury prevention</topic><topic>Intensive care</topic><topic>Intubation</topic><topic>Length of stay</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Patients</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Rib Fractures - complications</topic><topic>Trauma</topic><topic>Trauma Centers</topic><topic>Triage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Johnson, Emily H.</creatorcontrib><creatorcontrib>Brockman, Valerie</creatorcontrib><creatorcontrib>Schmoekel, Nathan</creatorcontrib><creatorcontrib>Schroeppel, Thomas J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Johnson, Emily H.</au><au>Brockman, Valerie</au><au>Schmoekel, Nathan</au><au>Schroeppel, Thomas J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Effect of Frailty in Predicting Outcomes of Rib Fractures Among Elderly Patients</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2024-08</date><risdate>2024</risdate><volume>90</volume><issue>8</issue><spage>1994</spage><epage>1999</epage><pages>1994-1999</pages><issn>0003-1348</issn><issn>1555-9823</issn><eissn>1555-9823</eissn><abstract>Introduction
Rib fractures are consequential injuries for geriatric trauma patients. Frailty has been associated with adverse outcomes in this population. The Rib Fracture Frailty Index (RFF) and 5-factor modified Frailty Index (mFI) are 2 validated frailty metrics. Research assessing inclusion of frailty metrics in geriatric rib fractures triage protocols is limited.
Methods
A retrospective cohort study was performed for trauma patients ≥50 years old with rib fractures admitted to a Level I trauma center, which currently uses percent predicted forced vital capacity (FVC%) to triage rib fractures patients. Frailty metrics (RFF & mFI) were calculated retrospectively, stratifying patients as low, moderate, or severe frailty. Unfavorable discharge disposition (UDD) was defined as discharge to facility or death. Unadjusted and adjusted odds ratios were used to assess frailty with outcome variables.
Results
In total, 834 patients were included from August 2018 - May 2023, with mean age of 69.1. A majority had low frailty (64.0 vs 40.3%), followed by moderate frailty (21.1 vs 30.7%), then severe frailty (14.9 vs 29.0%) for RFF and mFI, respectively. Age, sex, and ISS differed between groups. For RFF, increased frailty was associated with longer hospital and ICU length of stay. Neither frailty metric was associated with unplanned ICU transfer or intubation. In the adjusted analysis, frail patients were more likely to have UDD (OR 8.9, CI 3.4-23.0, P < .0001).
Conclusion
While both frailty metrics were predictive of UDD, neither was associated with ICU transfer or intubation, suggesting that frailty does not enhance the accuracy of our current protocol using FVC%.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>38538583</pmid><doi>10.1177/00031348241241704</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-2133-4950</orcidid></addata></record> |
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| subjects | Age Aged Aged, 80 and over Chronic obstructive pulmonary disease Clinical medicine Clinical practice guidelines Emergency medical care Female Females Fractures Frail Elderly - statistics & numerical data Frailty Frailty - complications Frailty - diagnosis Gastroesophageal reflux Geriatric Assessment - methods Geriatrics Glasgow Coma Scale Humans Injury prevention Intensive care Intubation Length of stay Length of Stay - statistics & numerical data Male Middle Aged Mortality Patients Regression analysis Retrospective Studies Rib Fractures - complications Trauma Trauma Centers Triage |
| title | The Effect of Frailty in Predicting Outcomes of Rib Fractures Among Elderly Patients |
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