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The impact of frailty on failure-to-rescue in geriatric trauma patients: A prospective study

Joseph, Bellal MD; Phelan, Herb MD, MPH; Hassan, Ahmed MD; Orouji Jokar, Tahereh MD; O’Keeffe, Terence MD; Azim, Asad MD; Gries, Lynn MD; Kulvatunyou, Narong MD; Latifi, Rifat MD; Rhee, Peter MD, MPH

Journal of Trauma and Acute Care Surgery: December 2016 - Volume 81 - Issue 6 - p 1150–1155
doi: 10.1097/TA.0000000000001250
WTA 2016 Plenary Papers

INTRODUCTION Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients.

METHODS We performed a prospective cohort study of all elderly (age ≥ 65 years) trauma patients presenting at our level one trauma center. Patient’s frailty status was calculated utilizing the Trauma Specific Frailty Index (TSFI) within 24 hours of admission. Patients were stratified into non-frail, pre-frail, and frail. FTR was defined as death from a major complication (respiratory, infectious, cardiac, and renal). Binary logistic regression analysis was performed after adjusting for age, gender, injury severity (ISS), and vital parameters to assess the relationship between frailty status and FTR.

RESULTS A total of 368 elderly trauma patients were evaluated of which 25% (n = 93) were non-frail, 38% (n = 139) pre-frail, and 37% (n = 136) frail. Overall, 30% of the patients developed in-hospital complications; of them, mortality occurred in 26% of the patients (FTR group). In the FTR group, 69% of the patients were frail compared to 17% pre-frail and 14% non-frail (p = 0.002). On multivariate regression analysis for predictors of FTR, frail status was an independent predictor of FTR (OR [95% CI] = 2.67 [1.37–5.20]; p = 0.004). On sensitivity analysis, positive predictive value of TSFI for FTR was 69% and negative predictive value for FTR was 67%.

CONCLUSION In elderly trauma patients, the presence of frailty increased the odds of FTR almost threefold as compared to non-frail. Although FTR has been considered as an indicator of health care quality, the findings of this study suggest that frailty status independently contributes to FTR. This needs to be considered in the future development of quality metrics, particularly in the case of geriatric trauma patients.

LEVEL OF EVIDENCE Prognostic study, level II.

Supplemental digital content is available in the text.

From the Department of Surgery (B.J., A.H., T.O.J., T.O.K., A.A., L.G., N.K., R.L., P.R.), Division of Trauma, Critical Care, Burns and Emergency Surgery, University of Arizona, Tucson, Arizona; and Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery (H.P.), University of Texas Southwestern Medical Center, Dallas, Texas.

Submitted: February 16, 2016, Revised: June 3, 2016, Accepted: July 18, 2016, Published online: September 16, 2016.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Bellal Joseph, MD, Department of Surgery, Division of Trauma, Critical Care, Burns, and Emergency Surgery, University of Arizona, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ 85724; e-mail:

© 2016 Lippincott Williams & Wilkins, Inc.