title: Frailty in trauma: A systematic review of the surgical literature for clinical assessment tools.
abstract: BACKGROUND
  Elderly trauma patients have outcomes worse than those of similarly injured younger patients. Although patient age and comorbidities explain some of the difference, the contribution of frailty to outcomes is largely unknown because of the lack of assessment tools developed specifically to assess frailty in the trauma population. This systematic review of the surgical literature identifies currently available frailty clinical assessment tools and evaluates the potential of each instrument to assess frailty in elderly patients with trauma.
  
  
  METHODS
  This review was registered with PROSPERO (the international prospective register of systematic reviews, registration number CRD42014015350). Publications in English from January 1995 to October 2014 were identified by a comprehensive search strategy in MEDLINE, EMBASE, and CINAHL, supplemented by manual screening of article bibliographies and subjected to three tiers of review. Forty-two studies reporting on frailty assessment tools were selected for analysis. Criteria for objectivity, feasibility in the trauma setting, and utility to predict trauma outcomes were formulated and used to evaluate the tools, including their subscales and individual items.
  
  
  RESULTS
  Thirty-two unique frailty assessment tools were identified. Of those, 4 tools as a whole, 2 subscales, and 29 individual items qualified as objective, feasible, and useful in the clinical assessment of trauma patients. The single existing tool developed specifically to assess frailty in trauma did not meet evaluation criteria.
  
  
  CONCLUSIONS
  Few frailty assessment tools in the surgical literature qualify as objective, feasible, and useful measures of frailty in the trauma population. However, a number of individual tool items and subscales could be combined to assess frailty in the trauma setting. Research to determine the accuracy of these measures and the magnitude of the contribution of frailty to trauma outcomes is needed.
  
  
  METHODS
  Systematic review, level III.
authors.affiliation: From the Trauma Service, Scripps Mercy Hospital, San Diego, California.
authors.forename: Victoria S
authors.initials: VS
authors.lastname: McDonald
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Thompson
authors.forename: Paul R
authors.initials: PR
authors.lastname: Lewis
authors.forename: C Beth
authors.initials: CB
authors.lastname: Sise
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sise
authors.forename: Steven R
authors.initials: SR
authors.lastname: Shackford
mesh_terms: D000367:Age Factors; D000368:Aged; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D009017:Morbidity; D010506:Periodicals as Topic; D018570:Risk Assessment / Q000379:methods*; D014194:Traumatology; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology*