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Can the 5-item Modified Frailty Index Predict Outcomes in Geriatric Trauma? A National Database Study

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Abstract

Background

Frailty results in increased vulnerability to adverse outcomes following trauma. We investigated the association between the 5-item modified frailty index (mFI-5) and outcomes in geriatric trauma patients.

Methods

The 2011–2016 Trauma Quality Improvement Program database was used to study outcomes in patients ≥ 65 years old. The mFI-5 was measured and categorized into no frailty (mFI-5 = 0), moderate frailty (mFI-5 = 0.2), and severe frailty (mFI-5 ≥ 0.4). Multivariable logistic regression analyses were performed to identify independent factors of mortality and complications.

Results

26,963 cases met the inclusion criteria, of whom 25.5% were not frail, 38% were moderately frail, and 36.6% were severely frail. Mean age (± SD) was 76 ± 7 years, 61.5% were male, and 97.8% sustained blunt injuries. Median Injury Severity Score (ISS) was 17 (IQR = 10–26), and the median Glasgow Coma Scale was 15 (IQR = 12–15). Overall mortality was 30.6%. Factors independently associated with mortality were age (OR = 1.07 per year, 95%CI 1.06–1.07), blunt trauma (OR = 1.44, 95%CI 1.19 –1.75), ISS (OR = 1.04 per unit increase in ISS, 95%CI 1.03–1.04), and severe frailty (OR = 1.23, 95%CI 1.15–1.32). Interestingly, male sex and GCS appeared to be protective factors with OR of 0.88 (95%CI 0.83 – 0.93) and 0.89 per point change in GCS (95%CI 0.88–0.9), respectively. Moderate (OR = 1.27, 95%CI 1.19–1.25) and severe frailty (OR = 1.49, 95%CI 1.–1.59) were significantly associated with in-hospital complications.

Conclusion

Moderate and severe frailty were significant predictors of complications. Only severe frailty was associated with short-term mortality. The mFI-5 can be used as an objective measure to stratify risks in geriatric trauma.

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Authors and Affiliations

  1. Department of Trauma and Burn–John H. Stroger, Jr. Hospital of Cook County, 1969 W Ogden Avenue Chicago, IL, 60612, USA

    Keren Guiab, Teresa Evans, Mahwash Siddiqi, Ghulam Saadat, William Brigode, Frederic Starr & Faran Bokhari

Authors
  1. Keren Guiab
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  2. Teresa Evans
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  3. Mahwash Siddiqi
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  4. Ghulam Saadat
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Correspondence to Keren Guiab.

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Guiab, K., Evans, T., Siddiqi, M. et al. Can the 5-item Modified Frailty Index Predict Outcomes in Geriatric Trauma? A National Database Study. World J Surg 46, 2328–2334 (2022). https://doi.org/10.1007/s00268-022-06637-3

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