scholarly journals The impact of frailty on trauma outcomes using the Clinical Frailty Scale

2021 ◽  
Author(s):  
Amari Thompson ◽  
Sunil Gida ◽  
Yasar Nassif ◽  
Carla Hope ◽  
Adam Brooks
Keyword(s):  
Clinical Frailty Scale ◽  
Trauma Outcomes ◽  
The Impact

The association of psychiatric and neurological comorbidities with outcomes in traumatic injury patients

2021 ◽  
pp. 009121742198914
Author(s):  
Jennifer Brady ◽  
R David Hayward ◽  
Elango Edhayan
Keyword(s):  
Length Of Stay ◽  
Psychiatric Illness ◽  
Traumatic Injury ◽  
Lower Mortality ◽  
Linear Modeling ◽  
Psychiatric Comorbidities ◽  
Trauma Outcomes ◽  
Hospital Stays ◽  
The Impact ◽  
The Relationship

Introduction Mental illness is a well-known risk factor for injury and injury recidivism. The impact of pre-existing psychiatric illness on trauma outcomes, however, has received less attention. Our study examines the relationship of pre-existing psychiatric illness on trauma outcomes including length of stay, cost, and mortality. Methods Patient data were obtained from the Healthcare Cost and Utilization Project’s State Inpatient Database. All patients admitted for trauma in the Detroit metropolitan area from 1/1/2006 to 12/31/2014 were included. The relationship between individual psychiatric comorbidities (depression, psychosis, and other neurological disorders) and outcomes were evaluated with logistic regression (mortality) and generalized linear modeling (length of stay and cost). Results Over 260,000 records were reviewed. Approximately one-third (29.9%) of patients had one or more psychiatric diagnoses. Patients with depression had longer hospital stays (RR = 1.12, p < 0.001) and higher costs (RR = 1.07, p < 0.001), but also lower mortality (OR = 0.69, p < 0.001). Patients with psychosis had longer stays (RR = 1.18, p < 0.001), higher costs (RR = 1.02, p = 0.002), and lower mortality (OR = 0.61, p < 0.001). Patients with other neurological comorbidities had higher mortality (OR = 1.23, p < 0.001), longer stays (RR = 1.29, p < 0.001), and higher costs (RR = 1.10, p < 0.001). Conclusion Patients with a psychiatric disorder required longer care and incurred greater costs, whereas mortality was higher for only those with a neurological disorder. Identifying patients’ psychiatric comorbidities at the time of admission for trauma may help optimize treatment. Addressing these conditions may help reduce the cost of trauma care.

scholarly journals LETTER TO THE EDITOR: COVID-19 AND THE CHALLENGES OF FRAILTY SCREENING IN OLDER ADULTS

2020 ◽  
pp. 1-2 ◽  
Author(s):  
R. O’Caoimh ◽  
S. Kennelly ◽  
E. Ahern ◽  
S. O’Keeffe ◽  
R.R. Ortuño
Keyword(s):  
Older Adults ◽  
Severe Acute Respiratory Syndrome ◽  
Healthcare Professionals ◽  
Management Strategies ◽  
Careful Examination ◽  
Geriatric Syndromes ◽  
Clinical Frailty Scale ◽  
The Impact ◽  
Recent Editorial ◽  
The Relationship

We read with interest the recent editorial examining the relationship between geriatric syndromes and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of Covid-19 (1), particularly the authors recognition of the need to identify frailty among older adults presenting with suspected symptoms and the importance of mobilising a range of healthcare professionals to tackle this disease (1). However, the identification of frailty and the utilisation of screening instruments by those without geriatric training and especially in acute care is challenging. Frailty is a complex condition. While age-associated, it is multi-dimensional and remains difficult to define (2). Although the Covid-19 pandemic has disproportionately affected older adults (1), data are lacking and pathophysiological mechanisms and the impact of differential management strategies on the course of the disease among older adults is uncertain (1). Further, the prevalence of frailty among those diagnosed, admitted or dying is not clearly reported at present. Nevertheless, the rationale for using frailty to identify those at risk and to allocate care has been correctly highlighted (1). We suggest however, that the use of instruments such as the Clinical Frailty Scale (CFS) (3) and particularly by non-specialised staff in this setting warrants more careful examination.

scholarly journals A Pilot Study of the Clinical Frailty Scale to Predict Frailty Transition and Readmission in Older Patients in Vietnam

2020 ◽  
Vol 17 (5) ◽  
pp. 1582
Author(s):  
Tan Van Nguyen ◽  
Thuy Thanh Ly ◽  
Tu Ngoc Nguyen
Keyword(s):  
Pilot Study ◽  
Older Patients ◽  
Rural And Remote ◽  
Clinical Frailty Scale ◽  
Frailty Status ◽  
Phone Calls ◽  
Increased Risk ◽  
Rural And Remote Areas ◽  
The Impact

Background. The Clinical Frailty Scale (CFS) is gaining increasing acceptance due to its simplicity and applicability. Aims. This pilot study aims to examine the role of CFS in identifying the prevalence of frailty, frailty transition, and the impact of frailty on readmission after discharge in older hospitalized patients. Methods. Patients aged ≥60 admitted to the geriatric ward of a hospital in Vietnam were recruited from 9/2018–3/2019 and followed for three months. Frailty was assessed before discharge and after three months, using the CFS (robust: score 1–2, pre-frail: 3–4, and frail: ≥5). Multivariate logistic regression was applied to investigate the associated factors of frailty transition and the impact of frailty on readmission. Results. There were 364 participants, mean age 74.9, 58.2% female. At discharge, 4 were robust, 160 pre-frail, 200 frail. Among the 160 pre-frail participants at discharge, 124 (77.5%) remained pre-frail, and 36 (22.5%) became frail after 3 months. Age (adjusted OR1.09, 95% CI 1.03–1.16), number of chronic diseases (adjusted OR 1.37, 95% CI 1.03–1.82), and polypharmacy at discharge (adjusted OR 3.68, 95% CI 1.15–11.76) were significant predictors for frailty after 3 months. A frailty status at discharge was significantly associated with increased risk of readmission (adjusted OR2.87, 95% CI 1.71–4.82). Conclusions. Frailty was present in half of the participants and associated with increased risk of readmission. This study suggests further studies to explore the use of the CFS via phone calls for monitoring patients’ frailty status after discharge, which may be helpful for older patients living in rural and remote areas.

scholarly journals Rationing care by frailty during the COVID-19 pandemic

2020 ◽  
Author(s):  
Emma Grace Lewis ◽  
Matthew Breckons ◽  
Richard P Lee ◽  
Catherine Dotchin ◽  
Richard Walker
Keyword(s):  
Critical Care ◽  
Older People ◽  
Adverse Outcome ◽  
Older Individuals ◽  
Short Term ◽  
Clinical Frailty Scale ◽  
Widespread Implementation ◽  
Care Outcomes ◽  
Resource Allocation Strategy ◽  
The Impact

Abstract The coronavirus disease 2019 (COVID-19) pandemic is disproportionately affecting older people and those with underlying comorbidities. Guidelines are needed to help clinicians make decisions regarding appropriate use of limited NHS critical care resources. In response to the pandemic, the National Institute for Health and Care Excellence published guidance that employs the Clinical Frailty Scale (CFS) in a decision-making flowchart to assist clinicians in assessing older individuals’ suitability for critical care. This commentary raises some important limitations to this use of the CFS and cautions against the potential for unintended impacts. The COVID-19 pandemic has allowed the widespread implementation of the CFS with limited training or expert oversight. The CFS is primarily being used to assess older individuals’ risk of adverse outcome in critical care, and to ration access to care on this basis. While some form of resource allocation strategy is necessary for emergencies, the implementation of this guideline in the absence of significant pressure on resources may reduce the likelihood of older people with frailty, who wish to be considered for critical care, being appropriately considered, and has the potential to reinforce the socio-economic gradient in health. Our incomplete understanding of this novel disease means that there is a need for research investigating the short-term predictive abilities of the CFS on critical care outcomes in COVID-19. Additionally, a review of the impact of stratifying older people by CFS score as a rationing strategy is necessary in order to assess its acceptability to older people as well as its potential for disparate impacts.

The impact of transfer on pediatric trauma outcomes

2016 ◽  
Vol 51 (5) ◽  
pp. 843-847 ◽  
Author(s):  
Tiffany Locke ◽  
Janelle Rekman ◽  
Maureen Brennan ◽  
Ahmed Nasr
Keyword(s):  
Pediatric Trauma ◽  
Trauma Outcomes ◽  
The Impact

The impact of antiplatelet drugs on trauma outcomes

2012 ◽  
Vol 73 (2) ◽  
pp. 492-497 ◽  
Author(s):  
Victor A. Ferraris ◽  
Andrew C. Bernard ◽  
Brannon Hyde ◽  
Paul A. Kearney
Keyword(s):  
Antiplatelet Drugs ◽  
Trauma Outcomes ◽  
The Impact

scholarly journals Different aspects of frailty and COVID-19: points to consider in the current pandemic and future ones

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hani Hussien ◽  
Andra Nastasa ◽  
Mugurel Apetrii ◽  
Ionut Nistor ◽  
Mirko Petrovic ◽  
...  
Keyword(s):  
Older Adults ◽  
Poor Response ◽  
Adverse Outcomes ◽  
Exclusion Criterion ◽  
Clinical Frailty Scale ◽  
Time Saving ◽  
Acute Setting ◽  
Icu Admission ◽  
The Impact ◽  
Microbiota Diversity

Abstract Background Older adults at a higher risk of adverse outcomes and mortality if they get infected with Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). These undesired outcomes are because ageing is associated with other conditions like multimorbidity, frailty and disability. This paper describes the impact of frailty on coronavirus disease 2019 (COVID-19) management and outcomes. We also try to point out the role of inflamm-ageing, immunosenescence and reduced microbiota diversity in developing a severe form of COVID-19 and a different response to COVID-19 vaccination among older frail adults. Additionally, we attempt to highlight the impact of frailty on intensive care unit (ICU) outcomes, and hence, the rationale behind using frailty as an exclusion criterion for critical care admission. Similarly, the importance of using a time-saving, validated, sensitive, and user-friendly tool for frailty screening in an acute setting as COVID-19 triage. We performed a narrative review. Publications from 1990 to March 2021 were identified by searching the electronic databases MEDLINE, CINAHL and SCOPUS. Based on this search, we have found that in older frail adults, many mechanisms contribute to the severity of COVID-19, particularly cytokine storm; those mechanisms include lower immunological capacity and status of ongoing chronic inflammation and reduced gut microbiota diversity. Higher degrees of frailty were associated with poor outcomes and higher mortality rates during and after ICU admission. Also, the response to COVID-19 vaccination among frail older adults might differ from the general population regarding effectiveness and side effects. Researches also had shown that there are many tools for identifying frailty in an acute setting that could be used in COVID-19 triage, and before ICU admission, the clinical frailty scale (CFS) was the most recommended tool. Conclusion Older frail adults have a pre-existing immunopathological base that puts them at a higher risk of undesired outcomes and mortality due to COVID-19 and poor response to COVID-19 vaccination. Also, their admission in ICU should depend on their degree of frailty rather than their chronological age, which is better to be screened using the CFS.

scholarly journals The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Christian Jung ◽  
◽  
Hans Flaatten ◽  
Jesper Fjølner ◽  
Raphael Romano Bruno ◽  
...  
Keyword(s):  
Intensive Care ◽  
Management Strategies ◽  
Prognostic Indicators ◽  
Prognostic Information ◽  
Clinical Frailty Scale ◽  
Intensive Care Patients ◽  
Prospective Multicentre Study ◽  
Frail Patients ◽  
Large Numbers ◽  
The Impact

Abstract Background The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. Methods A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. Results The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. Conclusion Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265, registered 19 March 2020.

scholarly journals 558 PREVALENCE AND IMPACT OF FRAILTY IN PATIENTS HOSPITALISED WITH COVID-19. THE SALFORD EXPERIENCE IN WAVES 1 AND 2

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
A Khan ◽  
F R Espinoza ◽  
T Kneen ◽  
A Dafnis ◽  
H Allafi ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Proportional Hazards ◽  
Hospital Admissions ◽  
Cox Proportional Hazards ◽  
Vulnerable Group ◽  
Clinical Frailty Scale ◽  
Patient Demographics ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
The Impact

Abstract Introduction The COVID-19 pandemic has had an extensive impact on the frail older population, with significant rates of COVID-related hospital admissions and deaths amongst this vulnerable group. There is little evidence of frailty prevalence amongst patients hospitalised with COVID-19, nor the impact of frailty on their survival. Methods Prospective observational study of all consecutive patients admitted to Salford Royal NHS Foundation (SRFT) Trust between 27th February and 28th April 2020 (wave 1), and 1st October to 10th November 2020 (wave 2) with a diagnosis of COVID-19. The primary endpoint was in-hospital mortality. Patient demographics, co-morbidities, admission level disease severity (estimated with CRP) and frailty (using the Clinical Frailty Scale, score 1–3 = not frail, score 4–9 = frail) were collected. A Cox proportional hazards regression model was used to assess the time to mortality. Results A total of 693 (N = 429, wave 1; N = 264, wave 2) patients were included, 279 (N = 180, 42%, wave 1; N = 104, 38%, wave 2) were female, and the median age was 72 in wave 1 and 73 in wave 2. 318 (N = 212, 49%, wave 1; N = 106, 39%, wave 2) patients presenting were frail. There was a reduction in mortality in wave 2, adjusted Hazard ratio (aHR) = 0.60 (95%CI 0.44–0.81; p = 0.001). There was an association between frailty and mortality aHR = 1.57 (95%CI 1.09–2.26; p = 0.015). Conclusion Frailty is highly prevalent amongst patients of all ages admitted to SRFT with COVID-19. Higher scores of frailty are associated with increased mortality.

scholarly journals The impact of delayed mobilization on post-discharge outcomes after emergency abdominal surgery: A prospective cohort study in older patients

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241554 ◽  
Author(s):  
Jenelle L. Pederson ◽  
Raj S. Padwal ◽  
Lindsey M. Warkentin ◽  
Jayna M. Holroyd-Leduc ◽  
Adrian Wagg ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Tertiary Care ◽  
Functional Decline ◽  
Surgical Patients ◽  
Care Needs ◽  
Post Discharge ◽  
Clinical Frailty Scale ◽  
Increased Risk ◽  
The Impact ◽  
Emergency Abdominal Surgery

Surgeons are increasingly treating seniors with complex care needs who are at high-risk of readmission and functional decline. Yet, the prognostic importance of post-operative mobilization in older surgical patients is under-investigated and remains unclear. Thus, we evaluated the relationship between post-operative mobilization and events after hospital discharge in older people. Overall, 306 survivors of emergency abdominal surgery aged ≥65y who required help with <3 activities of daily living were prospectively followed at two Canadian tertiary-care hospitals. Time until mobilization after surgery was attained from hospital charts and a priori defined as ‘delayed’ (≥36h) or ‘early’ (<36h). Primary outcomes for 30-day and 6-month all-cause readmission/death after discharge were assessed in multivariable logistic regression. Patients had a mean age of 76 ± 7.7 years, 45% were women, 41% were ‘vulnerable-to-moderately-frail’, according to the Clinical Frailty Scale. Most common reasons for admission were gallstones (23%), intestinal obstructions (21%), and hernia (17%). Median time to post-operative mobilization was 19h (interquartile range 9−35); 74 (24%) patients had delayed mobilization. Delayed mobilization was independently associated with higher risk of 30-day readmission/death (19 [26%] vs. 22 [10%], P<0.001; adjusted odds ratio [aOR] 2.24, 95%CI 0.99–5.06, P = 0.05), but this was not statistically significant at 6-months (38 [51%] vs. 64 [28%], P<0.001; aOR 1.72, 95%CI 0.91−3.25, P = 0.1). One-quarter of older surgical patients stayed in bed for 1.5 days post-operatively. Delayed mobilization was associated with increased risk of short-term readmission/death. As older, more frail patients undergo surgery, mobilization of older surgical patients remains an understudied post-operative factor. Trial registration: clinicaltrials.gov identifier: NCT02233153

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