Timing and methods of frailty assessments in geriatric trauma patients: A systematic review |
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| Affiliation: | 1. Department of Emergency Medicine, The Royal Melbourne Hospital, VIC, Australia;2. Trauma Service, The Royal Melbourne Hospital, VIC, Australia;3. Department of Medicine and Aged Care, The Royal Melbourne Hospital, VIC, Australia;4. Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, England;1. Department of Emergency Medicine, The Royal Melbourne Hospital, VIC, Australia;2. Trauma Service, The Royal Melbourne Hospital, VIC, Australia;3. Department of Medicine and Aged Care, The Royal Melbourne Hospital, VIC, Australia;4. Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, England;1. Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China;2. Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, 215300, China;1. Center for Surgery and Public Health, Brigham and Women''s Hospital, Boston, MA;2. Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR;1. Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China;2. Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, 215300, China;1. Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan;2. Emergency and Trauma Center, Kameda Medical Center, Kamogawa, Chiba, Japan;1. Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women''s Hospital, Boston, MA;2. Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Brigham and Women''s Hospital, Boston, MA;3. Division of Aging, Department of Medicine, Brigham and Women''s Hospital, Boston, MA;4. Surgical ICU Translational Research Center, Brigham and Women''s Hospital, Boston, MA |
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| Abstract: | IntroductionThe trauma population is aging and better prognostic measures for geriatric trauma patients are required. Frailty rather than age appears to be associated with poor outcomes. This systematic review aimed to identify the optimum frailty assessment instrument and timing of assessment in patients aged over 65 years admitted to hospital after traumatic injury. The secondary aim was to evaluate outcomes associated with frailty in elderly trauma populations.MethodsThis systematic review was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42018090620). A MEDLINE and EMBASE literature search was conducted from inception to June 2019 combining the concepts of injury, geriatric, frailty, assessment and prognosis. Included studies were in patients 65 years or older hospitalised after injury and exposed to an instrument meeting consensus definition for frailty assessment. Study quality was assessed using criteria for review of prognostic studies combined with a GRADE approach.ResultsTwenty-eight papers met inclusion criteria. Twenty-eight frailty or component instruments were reported, and assessments of pre-injury frailty were made up to 1-year post injury. Pre-injury frailty prevalence varied from 13% (13/100) to 94% (17/18), with in-hospital mortality rates from 2% (5/250) to 33% (6/18). Eleven studies found an association between frailty and mortality. Eleven studies reported an association between frailty and a composite outcome of mortality and adverse discharge destination. Generalisability and assessment of strength of associations was limited by single centre studies with inconsistent findings and overlapping cohorts.ConclusionsAssociations between frailty and adverse outcomes including mortality in geriatric trauma patients were demonstrated despite a range of frailty instruments, administering clinicians, time of assessment and data sources. Although evidence gaps remain, incorporating frailty assessment into trauma systems is likely to identify geriatric patients at risk of adverse outcomes. Consistency in frailty instruments and long-term geriatric specific outcome measures will improve research relevance.Level of evidence: Level III prognostic. |
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| Keywords: | Frailty Geriatric Trauma Screening Risk assessment |
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