scholarly journals Feasibility and accuracy of ED frailty identification in older trauma patients: a prospective multi-centre study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Heather Jarman ◽  
Robert Crouch ◽  
Mark Baxter ◽  
Chao Wang ◽  
George Peck ◽  
...  
Keyword(s):  
Major Trauma ◽  
Frailty Index ◽  
Traumatic Injury ◽  
Assessment Tools ◽  
Screening Tools ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Clinical Frailty Scale ◽  
Multi Centre Study ◽  
Trauma Centres

Abstract Background The burden of frailty on older people is identifiable by its adverse effect on mortality, morbidity and long term functional and health outcomes. In patients suffering from a traumatic injury there is increasing evidence that it is frailty rather than age that impacts greatest on these outcomes and that early identification can guide frailty specific care. The aim of this study was to evaluate the feasibility of nurse-led assessment of frailty in older trauma patients in the ED in patients admitted to major trauma centres. Methods Patients age 65 years and over attending the Emergency Departments (ED) of five Major Trauma Centres following traumatic injury were enrolled between June 2019 and March 2020. Patients were assessed for frailty whilst in the ED using three different screening tools (Clinical Frailty Scale [CFS], Program of Research to Integrate Services for the Maintenance of Autonomy 7 [PRIMSA7], and the Trauma Specific Frailty Index [TSFI]) to compare feasibility and accuracy. Accuracy was determined by agreement with geriatrician assessment of frailty. The primary outcome was identification of frailty in the ED using three different assessment tools. Results We included 372 patients whose median age was 80, 53.8% of whom were female. The most common mechanism of injury was fall from less than 2 m followed by falls greater than 2 m. Completion rates for the tools were variable, 31.9% for TSFI, compared to 93% with PRISMA7 and 98.9% with the CFS. There was substantial agreement when using CFS between nurse defined frailty and geriatrician defined frailty. Agreement was moderate using PRISMA7 and slight using TSFI. Conclusions This prospective study has demonstrated that screening for frailty in older major trauma patients within the Emergency Department is feasible and accurate using CFS. Trial registration ISRCTN, ISRCTN10671514. Registered 22 October 2019

scholarly journals 251 The frailty in major trauma study (FRAIL-T): feasibility of nurse lead frailty assessment in elderly trauma and the impact on outcomes

2020 ◽  
Vol 37 (12) ◽  
pp. 840.2-840
Author(s):  
Heather Jarman ◽  
Robert Crouch ◽  
Mark Baxter ◽  
Bebhinn Dillane ◽  
Chao Wang ◽  
...  
Keyword(s):  
Best Practice ◽  
Major Trauma ◽  
Frailty Index ◽  
Kappa Statistic ◽  
Trauma Team ◽  
Trauma Patients ◽  
Clinical Frailty Scale ◽  
Frailty Assessment ◽  
Trauma Population ◽  
The Impact

Aims/Objectives/BackgroundFrailty screening for major trauma patients has recently become part of the best practice commissioning tariff within NHS England, yet there is no consensus as to who should carry out this assessment or which tool best identifies frailty in the Emergency Department (ED). As the trauma population ages there is a need for accurate early identification of frailty in the ED to underpin frailty specific major trauma pathways. The primary aim of this study was to determine the feasibility and accuracy of ED nurse-led frailty assessment in patients ≥ 65 years admitted to Major Trauma Centres (MTCs).Methods/DesignA prospective observational study was conducted across five UK MTCs, enrolling 370 participants over nine months. Eligible patients were aged 65 or more requiring trauma team activation. Frailty was assessed in the ED using three different tools: Trauma Specific Frailty Index (TSFI); Clinical Frailty Scale (CFS); PRISMA-7. ED nurse frailty assessment was correlated with Geriatrician assessment within 72 hours of admission using Spearman’s correlation coefficient and kappa statistic for measuring the interrater agreement.Results/ConclusionsComplete frailty assessments were calculated for CFS in 99.4% of patients, PRISMA7 in 95.9% and TSFI in 37.58%. Rates of frailty differed between tools: CFS 32%, PRISMA7 57% and TSFI 92% whilst Geriatrician determined frailty was 37%. In all tools frail patients were older (p<0.001) and falls <2 m were the leading mechanism of injury (p<0.05). CFS showed both strong correlation (rs 0.639,p<0.001) and substantial agreement (kappa 0.637,p<0.001) with Geriatrician assessment within 72 hours of admission.ED nurses can accurately assess older major trauma patients for frailty using the Clinical Frailty Scale. These findings support assessment of frailty in the ED in order to identify patients who would benefit from early frailty specific care.

Mechanisms of Injury Among the Amish Population in Central Pennsylvania

2021 ◽  
pp. 000313482110505
Author(s):  
Larissa Whitney ◽  
Kelly Bonneville ◽  
Madison Morgan ◽  
Lindsey L. Perea
Keyword(s):  
Pediatric Population ◽  
Traumatic Injury ◽  
Age Groups ◽  
Geographic Location ◽  
Future Research ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Injury Patterns ◽  
Level Of Evidence

Background Individuals presenting with traumatic injury in rural populations have significantly different injury patterns than those in urban environments. With an increasing Amish population, totaling over 33 000 in our catchment area, their unique way of life poses additional factors for injury. This study aims to evaluate differences in mechanism of injury, location of injury, and demographic patterns within the Amish population. We hypothesize that there will be an increased incidence of agriculture-related mechanisms of injury. Methods All Amish trauma patients presenting to our level I trauma center over 20 years (1/2000-4/2020) were retrospectively analyzed. Mechanism and geographic location of injury were collected. Demographic and clinical variables were compared between the age groups. Results There were 1740 patients included in the study with 36.4% (n = 634) ≤ 14 years. Only 10% (n = 174) were ≥ 65 years. The most common mechanism across all ages was falls. However, when separating out the pediatric population ( ≤ 14 years), 27.8% (n = 60) fell from a height on average > 8-10 feet. The most common geographic location of injury was at home in all age groups, except for the 15-24 year group, which was roadways. Discussion The Amish population poses a unique set of mechanisms of injury and thus injury patterns to rural trauma centers. We have found the most common injuries to be falls, buggy accidents, animal-related injuries, and farming accidents across all age groups. Future research and collaboration with other rural trauma centers treating large Amish populations would be beneficial to maximize injury prevention in this population. Level of Evidence Level 3a, epidemiological.

scholarly journals Visualizing Frailty: Exploring Radiographical Measures of Frailty in Trauma Patients

2021 ◽  
Vol 11 (3) ◽  
pp. 121-128
Author(s):  
Omolola Fakunle ◽  
Meet Patel ◽  
Victoria G. Kravets ◽  
Adam Singer ◽  
Robert Hernandez-Irizarry ◽  
...  
Keyword(s):  
Frailty Index ◽  
Traumatic Injury ◽  
Ct Scans ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Discharge Disposition ◽  
Psoas Muscles ◽  
Significant Difference ◽  
Modified Frailty Index ◽  
Relationship Of

Purpose: This study assessed the relationship of core muscle sarcopenia, myosteatosis, and L1 attenuation to the 5-factor modified frailty index (mFI-5), discharge disposition, and post-admission complications in orthopedic and general trauma patients. It was hypothesized that reduced sarcopenia, L1 attenuation, and increased myosteatosis is associated with higher mFI-5 scores (≥ 0.3), discharge into care, and increased post-admission complications.Methods: This prospective cohort study was performed at a Level 1 trauma center. Patients were surveyed and metrics of the mFI-5 were used. Frail was categorized as a mFI-5 score ≥ 0.3. Recent abdominal computed tomography (CT) scans were used to extract radiographical information of total psoas cross-sectional area, psoas myosteatosis, and L1 vertebrae attenuation.Results: There were 140 patients who consented to the study, of which 83 had available abdomen and pelvis CT scans. The mean age was 43.19 (± 17.36), and 65% were male (n = 52). When comparing the frail (16%, n = 13) and not frail (84%, n = 70) patients, there was a significant difference in mean psoas myosteatosis (p < 0.0001) and the attenuation of the L1 vertebrae (p < 0.001). On multivariate analysis when accounting for age, myosteatosis of the psoas muscles was predictive of an mFI-5 score ≥ 0.3.Conclusion: The findings suggest that myosteatosis and L1 attenuation are associated with frailty indices (mFI-5) after traumatic injury. Future studies are needed to prospectively assess the validity of both radiographical and index-based markers of frailty in predicting post-traumatic complications, mortality, and hospital utilization.

P4514Agreement and prognostic significance of 6 frailty tools in patients with chronic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Sze ◽  
P Pellicori ◽  
J Zhang ◽  
J Weston ◽  
A L Clark
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Frailty Index ◽  
Prognostic Significance ◽  
Assessment Tools ◽  
Screening Tools ◽  
Misclassification Rate ◽  
Frailty Assessment ◽  
Frail Patients

Abstract Background Frailty is common in patients with chronic heart failure (CHF) and is associated with adverse outcome. Many frailty tools are available, however, there is no standard way of evaluating frailty in patients with CHF. Purpose To report the prevalence of frailty, agreement and prognostic significance amongst 3 frailty assessment tools and 3 screening tools in CHF patients. Methods We comprehensively studied frailty using 6 frailty tools. Frailty screening tools include: Clinical frailty scale (CFS); Derby frailty index & Acute frailty network frailty criteria. Frailty assessment tools include: Fried criteria; Edmonton frailty score & Deficit index. Since there is no gold standard in evaluating frailty in CHF patients, for each of the frailty tools, we used the results of the other 5 tools to produce a combined frailty index which we used as a “standard” frailty tool. Subjects were defined as frail if so identified by at least 3 out of 5 tools. Results 467 consecutive ambulatory CHF patients (67% male, median age 76 (IQR: 69–82) years, median NTproBNP 1156 (IQR: 469–2463) ng/L) and 87 controls (79% male, median age 73 (IQR: 69–77 years) were studied. Prevalence of frailty was much higher in CHF patients than in controls (30–52% vs 2–15%, respectively). Amongst the frailty screening tools, DFI scored the greatest proportion of patients as frail (48%) while CFS scored the lowest proportion as frail (44%). Amongst the assessment tools, Fried criteria scored the greatest proportion of patients as frail (52%) while EFS scored the lowest proportion as frail (30%). Frail patients were older, have worse symptoms, higher NTproBNP and more co-morbidities compared to non-frail patients. Of the screening tools, CFS had the strongest agreement with assessment tools (kappa coefficient: 0.65–0.72, all p<0.001). CFS had the highest sensitivity (87%) and specificity (89%) amongst screening tools and the lowest misclassification rate (12%) amongst all 6 frailty tools in identifying frailty according to the combined frailty index. During a median follow-up of 559 days (IQR 512–629 days), 82 (18%) patients died. 55% (N=45) of frail patients died of non-cardiovascular causes. Worsening frailty as detected by all 6 frailty tools was associated with worse outcome. A base model for mortality prediction including sex, NYHA class (III/IV vs I/II), BMI, log NTproBNP and haemoglobin had a C-statistics of 0.78. Amongst frailty tools: CFS and Fried criteria increased model performance most compared with base model (c-statistics: 0.80 for both). Patients who were frail according to CFS had a 9 times greater mortality risk than non-frail patients (Figure). Conclusion Frailty is common in CHF patients and is associated with worse outcome. CFS is a simple screening tool which identifies a similar group as lengthy assessment tools and has similar prognostic significance. Frailty screening should be incorporated into routine care of patients with CHF. Acknowledgement/Funding None

scholarly journals Major trauma patients are not who you might think they are: a linked data study

2019 ◽  
Vol 16 ◽  
Author(s):  
Elizabeth Brown ◽  
Hideo Tohira ◽  
Paul Bailey ◽  
Daniel Fatovich ◽  
Judith Finn
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Motor Vehicle ◽  
High Energy ◽  
Categorical Variables ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Continuous Variables ◽  
Mechanism Of Injury ◽  
Young Males

IntroductionMajor trauma patients are often perceived as being young males injured by high energy transfer mechanisms. The aim of this study was to describe the demographics of major trauma patients who were transported to hospital by ambulance.MethodsThis is a retrospective cohort study of adult major trauma (injury severity score >15) patients transported to hospital by St John Western Australia emergency ambulance in metropolitan Perth, between 1 January 2013 and 31 December 2016. To describe the cohort, median and interquartile range (IQR) were used for continuous variables and counts and percentages for categorical variables. Differences between mechanism of injury groups were assessed using the Kruskal-Wallis test. Trauma deaths were defined as early (declared deceased within 24 hours) or late (declared deceased within 30 days). ResultsA total of 1625 patients were included. The median age was 51 years (IQR 30-75) and 1158 (71%) were male. Falls from standing were the most common mechanism of injury (n=460, 28%) followed by motor vehicle crashes (n=259, 16%). Falls from standing were responsible for the majority of early (n=45/175, 26%) and late deaths (n=69/158, 44%). A large number of early deaths also resulted from motorbike crashes (n=32/175, 18%) with a median age of 34 years (IQR 21-46, p<0.001). ConclusionMajor trauma is not only a disease of the young. More than half of the cohort was more than 51 years of age and the most common cause was a fall from standing. Pre-hospital care must evolve to address the needs of a changing trauma patient demographic.

scholarly journals Paramedic assessment of frailty: An exploratory study of perceptions of frailty assessment tools

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Wayne Harris ◽  
Peter Vincent Lucas ◽  
Helen Eyles ◽  
Leigh Parker
Keyword(s):  
Older Adults ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Frailty Index ◽  
Economic Benefits ◽  
Assessment Tools ◽  
Screening Tools ◽  
Hospital Environment ◽  
Significant Variable ◽  
Frailty Assessment

<p><strong>Introduction: </strong>Frailty is recognised as a significant variable in the health of older adults. Early identification by paramedics of those at risk of frailty may assist in timely entry to an appropriate clinical care pathway. Early referral to such pathways has been shown to improve patient outcomes and quality of life, as well as deliver economic benefits. To date, little research has been completed regarding assessment of frailty by paramedic professionals using validated assessment tools. The objective of this study was to determine paramedicine students’ perceptions of screening tools to facilitate assessment and knowledge of frailty of older adults. The Edmonton Frail Scale (EFS) and the Groningen Frailty Index (GFI) were determined suitable for this purpose.</p><p><strong>Methods</strong>: The research adopted a mixed methods approach using a survey tool developed to gather both qualitative and quantitative data from students at the completion of a structured aged care clinical placement. Thematic analysis of the qualitative data identified key features of the tools, while a Likert-type scale was used to measure perspectives about the suitability of the tools for use in paramedic practice.</p><p><strong>Results</strong>: Thirty-seven paramedicine students were invited to participate in the study. Thirteen were able to use both tools to conduct frailty assessments and submitted survey responses. Student perspectives indicated both the EFS and GFI are potentially suitable for paramedicine and as clinical learning tools regarding geriatric assessments. Median time to administer the tools was eight minutes for the EFS and ten minutes for the GFI.</p><p><strong>Conclusion</strong>: Paramedicine students support a frailty assessment tool to assist clinical decision making regarding older adults. Further appraisal of validated frailty assessment tools by operational paramedics in a pre-hospital environment is warranted to determine absolute utility for Australian paramedics.</p>

scholarly journals 322 Major Trauma in the Older Person - Major Challenges Ahead

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16 ◽  
Author(s):  
Rachael Doyle ◽  
Louise Brent ◽  
Aisling Connolly ◽  
Tomas Breslin ◽  
Sophie Jones ◽  
...  
Keyword(s):  
Older People ◽  
Independent Living ◽  
Major Trauma ◽  
Methodological Approach ◽  
Marked Change ◽  
Trauma Team ◽  
Research Network ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Medical Needs

Abstract Background The mean and median age of major trauma continues to increase for a mean of 36 years in the 1990's to 59 and 61 years respectively in 2016 and 2017. The age planning of major trauma has important implications for healthcare planning. Methods The major trauma audit was established by the National Office of Clinical Audit (NOCA) in 2013 and focuses on the most severely injured trauma patients in our healthcare system. The methodological approach is provided by the Trauma Audit and Research Network (TARN). Since 2016 all 26 eligible hospitals have been participating in the audit and the coverage is now 86%.Data has been collected on more than 15000 trauma patients to date. Results There were 5061 recorded major trauma cases of which 2233 (44%) were over 65 years in 2017. The most common form of injury (57%) was falls less than two metres (low falls) and this began aged 45 years. 50% of injuries occurred in patient's own home. Only 11% of people were received by a trauma team and this was even lower in the older adult. Older people were very unlikely to be pre-alerted to the Emergency Department prior to arrival. 64% of the mortality from major trauma occurred in the over 65 years. 6%, 7% and 10% of patients aged 65-74, 75-84 and over 85's respectively were discharged directly to nursing home. Conclusion There is a marked change in the age profile sustaining major trauma since the late 1990's. Patients today are older with more complex medical needs, have greater lengths of stay and many do not return to independent living. The most common mechanism of injury for older people is a low fall at home. We need to prevent low galls using a multidisciplinary, multi-agency approach.

Older people and major trauma

2009 ◽  
Vol 19 (2) ◽  
pp. 77-85 ◽  
Author(s):  
Elaine Cole ◽  
Antonia Lynch ◽  
Jackie Bridges ◽  
Anita West
Keyword(s):  
Older People ◽  
Major Trauma ◽  
Traumatic Injury ◽  
Psychological Impact ◽  
Age Groups ◽  
Adverse Outcomes ◽  
Practice Research ◽  
Trauma Patients ◽  
Policy Practice ◽  
Research And Education

SummaryMajor traumatic injury is a leading cause of death in younger age groups, but increasingly older people are affected also. Adverse outcomes, both physical and psychological, are associated with injury in the older population. This review aims to locate and describe the evidence relating to older people and major trauma in order to inform policy, practice, research and education. The published research and systematic reviews fall into three main topics: mechanism of traumatic injury in older people, the effects of co-morbidities on older trauma patients and outcomes following serious traumatic injury in older people. The psychological impact of traumatic injury and the resulting functional alteration cannot be underestimated in this group of patients.

scholarly journals Prevalence of frailty in patients referred to the kidney transplant waitlist

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0001892021
Author(s):  
George Worthen ◽  
Amanda Vinson ◽  
Héloise Cardinal ◽  
Steve Doucette ◽  
Nessa Gogan ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Proportional Hazards Model ◽  
Frailty Index ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Assessment Tools ◽  
Measurement Tool ◽  
Clinical Frailty Scale ◽  
Frailty Phenotype ◽  
The Mean

Background: Comparisons between frailty assessment tools for waitlist candidates are a recognized priority area for kidney transplantation. We compared the prevalence of frailty using three established tools in a cohort of waitlist candidates. Methods: Waitlist candidates were prospectively enrolled from 2016-2020 across five centers. Frailty was measured using the Frailty Phenotype (FP, as well as a 37 variable Frailty Index (FI), and the Clinical Frailty Scale (CFS). The FI and CFS were dichotomized using established cut-offs. Agreement was compared using kappa coefficients. Area under the receiver operator characteristic curves were generated to compare the FI and CFS (treated as continuous measures) to the FP. Unadjusted associations between each frailty measure and time to death or waitlist withdrawal were determined using an unadjusted Cox proportional hazards model. Results: Of 542 enrolled patients, 64% were male, 80% were white, and the mean age was 54+/-14. The prevalence of frailty by the FP was 16%. The mean FI score was 0.23+/-0.14 and the prevalence of frailty was 38% (score of >0.25). The median CFS score was 3 (IQR 2,3), and the prevalence was 15% (score of ≥4). Kappa values comparing the FP to the FI (0.438) and CFS (0.272) showed fair to moderate agreement. Area under the ROC curve for the FP and FI/CFS were 0.86 (good) and 0.69 (poor) respectively. Frailty by the CFS (HR 2.10; 95% CI (1.04, 4.24) and FI (HR 1.79; 95% CI 1.00,3.21) was associated with death or permanent withdrawal. The association between frailty by the FP and death/withdrawal was not statistically significant (HR 1.78; CI 0.786, 3.71). Conclusion: Frailty prevalence varies by measurement tool used, and agreement between these measurements is fair to moderate. This has implications for determining the optimal frailty screening tool for use in those being evaluated for kidney transplant.

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