Joseph B, Pandit V, Zangbar B, et al.
J Am Coll Surg 2014;219:10-7.e1
Publication date: July 1, 2014
Summary
Early prediction of discharge disposition is an important component in the management of trauma patients. The authors have previously demonstrated that frailty identified using the 50-variable Frailty Index is an independent predictor of unfavorable discharge disposition in geriatric trauma patients. However, they also found the Frailty Index to be an extensive and time consuming questionnaire that was difficult to implement in the acute setting of trauma.
The authors subsequently developed a modified 15-variable Trauma-Specific Frailty Index (TSFI) using the items from the 50-variable Frailty Index that were found to have the strongest association with unfavorable discharge disposition in a series of 100 consecutive patients. Then they performed a 2-year prospective observational study of 200 consecutive trauma patients older than 65 years presenting to their Level trauma center to validate their new TSFI.
Mean age was 77 years, median Injury Severity Score was 15, median Glasgow Coma Scale score was 14, and median Frailty Index score was 0.20. Fifty-nine patients (29.5%) had unfavorable discharge. After adjusting for various risk factors, frailty identified using the TSFI was the only significant predictor for unfavorable discharge disposition (odds ratio 1.5). Age was not predictive of unfavorable discharge disposition.
The authors conclude that the TSFI provides a convenient frailty scoring system that can aid clinicians in planning discharge disposition of geriatric trauma patients.