Frailty As A Predictor Of Negative Outcomes In Trauma Patients With Isolated Rib Fractures
University of Iowa Carver College of Medicine, Iowa City, IA
Objective. Frailty has become a tool used by providers to identify older patients at risk of poor outcomes. In patients with isolated rib fractures, adverse outcomes are associated with the number of rib fractures; however, studies suggest an association with frailty. Herein, we assessed whether the Canadian Study of Health and Aging clinical frailty scale (CSHA-CFS) can predict if patients are at increased risk for adverse outcomes.
Methods. Patients age 50 and older admitted for isolated rib fractures from July 2015 to June 2020 were retrospectively scored for frailty using the CSHA-CFS. Demographics, comorbidities, injury information, hospital course, and complications were collected. Primary endpoints were in-hospital mortality and respiratory complications. Secondary outcomes were hospital length of stay (LOS), ICU admission, non-respiratory complications (renal failure, septic shock, delirium), and discharge to higher level of care. Multivariate analyses were performed to assess the association between number of rib fractures and frailty with outcomes. P < 0.05 was considered significant.
Results. Controlling for age, gender, ISS, injury mechanism, and any comorbidities that showed significant differences, number of rib fractures was associated with developing pneumonia (OR = 1.206 [1.088-1.338]; p < 0.001), respiratory failure (OR = 1.237 [1.143-1.339], p < 0.001), requiring O2 during hospitalization (OR = 1.171 [1.087-1.262], p < 0.001), non-respiratory complications (OR = 1.120 [1.052-1.193], p < 0.001), LOS (OR = 1.057 [1.026-1.089], p < 0.001), number of days in the ICU (OR = 1.552 [1.290-1.867], p < 0.001), ventilator need (OR = 1.476 [1.105-1.972], p = 0.008), mortality (OR = 1.184 [1.057-1.326], p = 0.004), and discharge to long term acute care facilities (OR = 1.335 [1.119-1.594], p = 0.001). Frailty was associated with LOS (OR = 1.286 [0.979-1.688], p = 0.070), the development of non-respiratory complications (OR = 2.547 [1.201-5.401], p = 0.015), and discharge to SNF (OR = 6.051 [1.912-19.153], p = 0.002).
Conclusion. In our population, the number of rib fractures was associated with poor outcomes (longer LOS, mortality, complications). Frailty, measured using the CSHA-CFS, is not associated with increased mortality or respiratory complications but was associated with non-respiratory complications and discharge to higher level of care.
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