title: Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer?
abstract: BACKGROUND
  The frailty index (FI) has been shown to predict outcomes in geriatric patients. However, FI has never been applied as a prognostic measure after trauma. The aim of our study was to identify hospital admission factors predicting discharge disposition in geriatric trauma patients.
  
  
  METHODS
  We performed a 1-year prospective study at our Level 1 trauma center. All trauma patients 65 years or older were enrolled. FI was calculated using 50 preadmission variables. Patient's discharge disposition was dichotomized as favorable outcome (discharge home, rehabilitation) or unfavorable outcomes (discharge to skilled nursing facility, death). Multivariate logistic regression was performed to identify factors that predict unfavorable outcome.
  
  
  RESULTS
  A total of 100 patients were enrolled, with a mean (SD) age of 76.51 (8.5) years, 59% being males, median Injury Severity Score (ISS) of 14 (range, 9-18), median head Abbreviated Injury Scale (h-AIS) score of 2 (2-3), and median Glasgow Coma Scale (GCS) score of 13 (12-15). Of the patients, 69% had favorable outcome, and 31% had unfavorable outcome. On univariate analysis, FI was found to be a significant predictor for unfavorable outcome (odds ratio, 1.8; 95% confidence interval, 1.2-2.3). After adjusting for age, ISS, and GCS score in a multivariate regression model, FI remained a strong predictor for unfavorable discharge disposition (odds ratio, 1.3; 95% confidence interval, 1.1-1.8).
  
  
  CONCLUSIONS
  The concept of frailty can be implemented in geriatric trauma patients with similar results as those of nontrauma and nonsurgical patients. FI is a significant predictor of unfavorable discharge disposition and should be an integral part of the assessment tools to determine discharge disposition for geriatric trauma patients.
  
  
  METHODS
  Prognostic study, level II.
authors.affiliation: From the Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson, Arizona.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.forename: Moutamn
authors.initials: M
authors.lastname: Sadoun
authors.forename: Julie
authors.initials: J
authors.lastname: Wynne
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Mindy J
authors.initials: MJ
authors.lastname: Fain
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
mesh_terms: D015998:Abbreviated Injury Scale; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015600:Glasgow Coma Scale; D006304:Health Status; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*