From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
J Trauma Acute Care Surg. 2019 Nov;87(5):1172-1180. doi: 10.1097/TA.0000000000002458.
Different frailty scores have been proposed to measure frailty. No study has compared their predictive ability to predict outcomes in trauma patients. The aim of our study was to compare the predictive ability of different frailty scores to predict complications, mortality, discharge disposition, and 30-day readmission in trauma patients.
We performed a 2-year (2016-2017) prospective cohort analysis of all geriatric (age, >65 years) trauma patients. We calculated the following frailty scores on each patient; the Trauma-Specific Frailty Index (TSFI), the Modified Frailty Index (mFI) derived from the Canada Study of Health and Aging, the Rockwood Frailty Score (RFS), and the International Association of Nutrition and Aging 5-item a frailty scale (FS). Predictive models, using both unadjusted and adjusted logistic regressions, were created for each outcome. The unadjusted c-statistic was used to compare the predictive ability of each model.
A total of 341 patients were enrolled. Mean age was 76 ± 9 years, median Injury Severity Score was 13 [9-18], and median Glasgow Coma Scale score was 15 [12-15]. The unadjusted models indicated that both the TSFI and the RFS had comparable predictive value, as indicated by their unadjusted c-statistics, for mortality, in-hospital complications, skilled nursing facility disposition and 30-day readmission. Both TSFI and RFS models had unadjusted c-statistics indicating a relatively strong predictive ability for all outcomes. The unadjusted mFI and FS models did not have a strong predictive ability for predicting mortality and in-hospital complications. They also had a lower predictive ability for skilled nursing facility disposition and 30-day readmissions.
There are significant differences in the predictive ability of the four commonly used frailty scores. The TSFI and the RFS are better predictors of outcomes compared with the mFI and the FS. The TSFI is easy to calculate and might be used as a universal frailty score in geriatric trauma patients.
Prognostic, level III.
已经提出了不同的衰弱评分来衡量衰弱。尚无研究比较它们预测创伤患者结局的能力。我们的研究旨在比较不同的衰弱评分来预测创伤患者并发症、死亡率、出院去向和 30 天再入院的预测能力。
我们对所有老年（年龄>65 岁）创伤患者进行了为期 2 年（2016-2017 年）的前瞻性队列分析。我们对每位患者计算了以下衰弱评分：创伤特异性衰弱指数（TSFI）、源自加拿大健康与老龄化研究的改良衰弱指数（mFI）、Rockwood 衰弱评分（RFS）和国际营养与老龄化协会 5 项衰弱量表（FS）。使用未调整和调整后的逻辑回归分别为每个结果创建预测模型。使用未调整的 c 统计量比较每个模型的预测能力。
共纳入 341 例患者。平均年龄为 76±9 岁，中位数损伤严重度评分 13[9-18]，格拉斯哥昏迷评分中位数 15[12-15]。未调整模型表明，TSFI 和 RFS 的未调整 c 统计量表明，它们对死亡率、院内并发症、熟练护理机构去向和 30 天再入院具有相当的预测价值。TSFI 和 RFS 模型的未调整 c 统计量表明，它们对所有结局均具有较强的预测能力。未调整的 mFI 和 FS 模型对预测死亡率和院内并发症的能力不强。它们对熟练护理机构去向和 30 天再入院的预测能力也较低。
四种常用衰弱评分的预测能力存在显著差异。TSFI 和 RFS 比 mFI 和 FS 更能预测结局。TSFI 易于计算，可作为老年创伤患者的通用衰弱评分。
预后，III 级。
