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Observational Study
. 2024 Sep 14;24(1):759.
doi: 10.1186/s12877-024-05350-1.

Frailty and 6-month trajectory of elderly trauma patients over the age of 65 years admitted to intensive care unit for severe trauma: experience of a level 1 trauma center

Vincent Legros  1   2   3   4 , Pierre-Antoine Seube-Remy  5   6 , Thierry Floch  7 , Cindy Chauchard  5 , Marion Leclercq-Rouget  7 , Pierre-Alexandre Prevot-Minella  5 , Alice Duvivier  8 , Lucas Flamant  6   9 , Lukshe Kanagaratnam  10   8
Affiliations
Observational Study

Frailty and 6-month trajectory of elderly trauma patients over the age of 65 years admitted to intensive care unit for severe trauma: experience of a level 1 trauma center

Vincent Legros et al. BMC Geriatr. .

Abstract

Background: The aging global population forecasts a significant rise in severe trauma cases among individuals aged 65 and above. Frailty emerges as a paramount predictor of post-traumatic outcomes, surpassing age and trauma severity indices. Despite this, scant attention is given to the trajectory of elderly patients post-intensive care unit (ICU) stay following severe trauma, justifying this study. The objective of this study was to analyze trajectories (frailty, place of residence) following a major trauma requiring an ICU stay.

Materials and methods: An observational cohort study was conducted, leveraging data from a level 1 trauma center spanning 2018 to 2023. Inclusion criteria included elderly patients aged 65 and above admitted to the ICU for severe trauma. Data encompassed demographic profiles, trauma severity scores, clinical parameters, and frailty assessments sourced from the Traumabase database.

Results: Among 293 patients included 190 were non-frail, frailty was correlated with elevated mortality rates (114 (38.9%) at 6 months), heightened incidence of traumatic brain injuries, and notable declines in post-traumatic autonomy. Only 39.2% of patients had resumed residence at home six months post-injury, with a conspicuous trend towards institutionalization, particularly among frail individuals.

Conclusion: This study highlights the role of frailty in determining the outcomes of elderly patients following severe trauma. Frailty is associated with higher mortality, increased rates of institutionalization, and a decline in functional status. These results highlight the importance of assessing frailty in the trajectory of severely injured patients over the age of 65 years-old.

Keywords: Clinical frailty scale; Elderly patients; Mortality; Trajectory frailty; Trauma.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curve at 1 year. Kaplan-Meier survival curve, showing 1-year mortality respectively at 29.4% (56 patients) for non-frail patients, 60.8% (42 patients) for pre-frail patients and 70.6% (24 patients) for frail patients
Fig. 2
Fig. 2
Alluvial diagram of patients’ place of residence before and 6 months and 1 year after the accident. Alluvial diagram showing patients’ trajectories according to where they live, with milestones at 3, 6 months and during follow-up.At the end of follow-up, only 48.4% (142 patients) were living at home at least 1 year after the trauma, compared with 97.9% (287 patients) before the trauma. Data are expressed in number (percentage), End of Follow-up ranged from 6 months to 3 years, depending on the year of injury
Fig. 3
Fig. 3
Alluvial diagram of frailty before and 6 months after the accident. An alluvial diagram shows the trajectory of patients based on their frailty status, before and one year after the trauma. Of the 114 patients (38.9%) who died within one year, among the 190 patients (64.8%) who were non-frail, only 55 (18.7%) remained one year after the trauma. Data are expressed in number (percentage)
See this image and copyright information in PMC

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