Pre-Injury Frailty and Clinical Care Trajectory of Geriatric Trauma Patients: A Retrospective Cohort Analysis of A Large Level I US Trauma Center

BackgroundPre-injury frailty among older trauma patients is a predictor of increased morbidity and mortality. We sought to determine the relationship between frailty status and the care trajectories of older adult patients who underwent frailty screening in the emergency department (ED). MethodsUsing a retrospective cohort design of a single institutional trauma database, we pooled data on trauma patients, 65 years and older, who had frailty screening at ED presentation (N=987). The predictor variable was frailty status, measured as either robust, pre-frail, or frail. The outcome variables were measures of clinical care trajectory: inpatient admission, length of hospital stay, home discharge, and discharge to rehabilitation. We controlled for age, sex, race/ethnicity, body mass index, Charlson Comorbidity Index, injury type and severity, and Glasgow Coma Scale score. We performed multivariable logistic and quantile regressions to measure the influence of frailty on post-trauma care trajectories. ResultsThe mean (SD) age of the study population was 81 (9.0) years and the population was predominantly female (66%) and non-Hispanic White (64%). Compared to older adult trauma patients classified as robust, those categorized as frail had 2.8 (95% CI: 1.75 - 4.40), 0.4 (95% CI: 0.27 - 0.63), and 2.1 (95% CI: 1.38 - 3.27) times the adjusted odds of hospital admission, home discharge, and discharge to rehabilitation, respectively. Those classified as pre-frail (Adjusted MD: 1.0; 95% CI: 0.46 - 1.54) and frail (Adjusted MD: 2.0; 95% CI: 1.35 - 2.65) had longer lengths of hospital stay compared to those classified as robust. ConclusionPre-injury frailty is a predictor of care trajectories for older-adult trauma patients.