Predicting Adverse Hospital Discharge in Orthopaedic Trauma Patients Utilizing Common Medical Frailty Indices Público
Jin, David (Spring 2020)
Abstract
Background: Frailty is a risk indicator that has been validated to influence health outcomes in a variety of patients, including those who experience traumatic injury. There is a need for effective risk assessment tools to predict post-surgical outcomes in order to appropriately triage patients (both in-hospital and post-discharge) at high-risk of poor outcome. This study aims to prospectively determine which modified frailty index (mFI) [-11 vs -5 vs -15] best predicts adverse hospital discharge, defined as a destination other than home (rehab, nursing facility, long-term care).
Methods: Data was collected prospectively from all orthopedic trauma patients from April of 2019 to July of 2019 at Grady Memorial Hospital. We obtained data on patient demographics, injury details, comorbidities, and nutrition lab values (albumin). Frailty scores were calculated for each participant. Using univariate logistic regression, discharge dispositions were assessed for each index. Receiver operating characteristics (ROC) curves were generated to determine the regression accuracy.
Results: A total of 122 patients were included in the cohort. Mean age was 45 ± 18 years, 65% male, and 60% black. At discharge, 73% (n=89) patients went home. The mFI-5 yielded the highest predictability for non-home discharges (OR 5.1, 95% CI 1.9-13.7, p<0.001); ROC 63.1%. The mFI-11 (ROC 53.8%) and the mFI-15 (ROC 53.7%) were not significantly associated with a non-home discharge. Incorporating hypoalbuminemia as a frailty indicator into the model increased the AUC for both the 11-item and the 5-item, respectively (ROC 57.2% and 64.1%).
Conclusions: We have prospectively demonstrated that a non-home discharge in frail, orthopedic trauma patients is associated with an mFI-5 ≥ 0.27 and potentiated by hypoalbuminemia. The mFI-5 appears to be the most accurate tool of the three indices as evidenced by its highest ROC. The mFI-5 is a simplistic and predictive tool that can be easily implemented for predicting adverse hospital discharge in trauma patients.
Table of Contents
Introduction…………………………………………………………………………... 1
Methods…………………………………………………………………………......... 2
Results…………………………………………………………………………….……. 4
Discussion………………………………………………………………………..……. 5
References……………………………………………………………………..………. 11
Tables & Figures……………………………………………………………..………. 13
Appendices………………………………………………………………….………….. 16
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