Kwame Akuamoah-Boateng, DNP, MSN, RN
Lead- ACSS Division APP
Virginia Commonwealth University Health
Richmond, VA
Disclosure information not submitted.
Brittany Horvath, ACNP
NP
Virginia Commonwealth University Medical Center, United States
Disclosure information not submitted.
James Whelan, MD, FACS
Faculty
Virginia Commonwealth University Health System, United States
Disclosure information not submitted.
Christopher Borchers, ACNP-BC
nurse practitioner
n/a, United States
Disclosure information not submitted.
Stefan Leichtle, MD, FACS
Faculty
Virginia Commonwealth University, United States
Disclosure information not submitted.
Michel Aboutanos, MD
Chair of Division of ACSS
Medical College of Virginia, United States
Disclosure information not submitted.
Title: The Effect Trauma Admission on Adverse Outcomes and Progression of Frailty
INTRODUCTION/HYPOTHESIS: Frailty is recognized as a predictor of complications and poor outcomes in the geriatric patient population. Our aim was to study the prevalence of frailty and outcomes in patients following trauma admission to a critical care unit. We hypothesize the presence of admission frailty will be an independent predictor of higher mortality, increased length of stay, and will progress as a result of traumatic injuries post hospitalization within all age groups older than 24years old.
Methods: A prospective observational study was performed over a 3-month period on trauma patients in a trauma critical care unit. An admission frailty and at 6 weeks post-discharge frailty was determine using the 5-item FRAIL Scale. The study was approved by the Institutional Review Board Ethics Committee. All comparisons were performed at a level of significance of p ≤ 0.05.
Results: Of the 110 patients admitted to the Trauma ICU from January to March 2021, 25% were considered frail vs. 20% pre-frail vs. 55% non-frail. Mean age of frailty was 70 years old, the youngest age being 48 years old. Pre-frail patients with a mean age of 58 years old, a minimum age of 31years old. Comparing frail vs. non-frail patients’, the frail patients had a higher mortality rate (57.1 vs 42.86% p- 0.16); Covid positivity (80 vs 20%, p- 0.03); ETOH (75 vs 25%, p-0.08); sepsis diagnosis (100% vs 0 p-0.09). No statistical significance in ICU LOS (p-0.16) and injury severity score (p-0.43). Statistical significance was achieved between the groups for HTN (p-< 0.0001) and DM (p-0.03). At 6-week post discharge frailty assessment of 67 patients demonstrated statistical significance between admission and post discharge frailty (p-< 0.0001). 25% of the admitted non-frail patients progress to frail state on post-discharge evaluation. 21% of the admitted non-frail patients progress to a pre-frail state. 19% percent of the admitted pre-frail patients progress to a frail state.
Conclusions: Although statistical significance was not achieved in mortality and LOS, both groups trended in the direction towards significance, calling for a larger randomized control trial. We did, however, demonstrate that trauma admission increases frailty scores in all groups. This trend was most revealing in the non-geriatric group.