Forssten Maximilian Peter, Ekestubbe Lovisa, Cao Yang, Mohammad Ismail Ahmad, Ioannidis Ioannis, Sarani Babak, Mohseni Shahin
Department of Orthopedic Surgery, Orebro University Hospital, Orebro, 701 85, Sweden.
School of Medical Sciences, Orebro University, Orebro, 702 81, Sweden.
Eur J Trauma Emerg Surg. 2025 Mar 4;51(1):126. doi: 10.1007/s00068-025-02775-0.
Frailty has gained recognition as a crucial determinant of patient outcomes following traumatic spinal injury (TSI), particularly due to its increasing incidence in elderly populations. The aim of the current investigation was therefore to compare the ability of several frailty scores to predict adverse outcomes in surgically managed isolated TSI patients without spinal cord injury.
All adult patients (18 years or older) who suffered an isolated TSI due to blunt trauma, and required surgical management, were extracted from the 2013-2021 Trauma Quality Improvement Program database. The ability of the Orthopedic Frailty Score (OFS), the Hospital Frailty Risk Score (HFRS), the 11-factor (11-mFI) and 5-factor (5-mFI) modified frailty index, as well as the Johns Hopkins Frailty Indicator to predict adverse outcomes was compared based on the area under the receiver-operating characteristic curve (AUC). Subgroup analyses were also performed on patients who were ≥ 65 years old and those who were injured due to a ground-level fall (GLF).
A total of 39,449 patients were selected from the TQIP database. The 5-mFI and 11-mFI outperformed all other frailty scores when predicting in-hospital mortality (5-mFI AUC: 0.73) (11-mFI AUC: 0.73), any complication (5-mFI AUC: 0.65) (11-mFI AUC: 0.65), and FTR (5-mFI AUC: 0.75) (11-mFI AUC: 0.75). Among the 14,257 geriatric patients, however, the OFS demonstrated the highest predictive ability for in-hospital mortality (AUC: 0.65). The OFS (AUC: 0.64) also performed on the same level as both the 5-mFI (AUC: 0.63) and the 11-mFI (AUC: 0.63) when predicting FTR in this population. Among the 9616 patients who were injured due to a GLF, the OFS performed on par with the 5-mFI and 11-mFI when predicting in-hospital mortality and FTR.
Simpler scores like the 5-factor modified Frailty Index and Orthopedic Frailty Score outperform or perform on par with more complicated frailty scores when predicting mortality, complications, and failure-to-rescue in surgically managed isolated traumatic spinal injury patients without spinal cord injury, particularly among geriatric patients and those injured in a GLF.
衰弱已被公认为是创伤性脊髓损伤（TSI）后患者预后的关键决定因素，尤其是鉴于其在老年人群中的发病率不断上升。因此，本研究的目的是比较几种衰弱评分在预测非脊髓损伤的手术治疗孤立性TSI患者不良预后方面的能力。
从2013 - 2021年创伤质量改进计划数据库中提取所有因钝性创伤导致孤立性TSI且需要手术治疗的成年患者（18岁及以上）。基于受试者工作特征曲线下面积（AUC）比较骨科衰弱评分（OFS）、医院衰弱风险评分（HFRS）、11因素（11 - mFI）和5因素（5 - mFI）改良衰弱指数以及约翰霍普金斯衰弱指标预测不良预后的能力。还对年龄≥65岁的患者和因地面跌倒（GLF）受伤的患者进行了亚组分析。
共从TQIP数据库中选取了39449例患者。在预测院内死亡率（5 - mFI AUC：0.73）（11 - mFI AUC：0.73）、任何并发症（5 - mFI AUC：0.65）（11 - mFI AUC：0.65）和未能挽救（FTR）（5 - mFI AUC：0.75）（11 - mFI AUC：0.75）方面，5 - mFI和11 - mFI优于所有其他衰弱评分。然而，在14257例老年患者中，OFS对院内死亡率的预测能力最高（AUC：0.65）。在该人群中预测FTR时，OFS（AUC：0.64）与5 - mFI（AUC：0.63）和11 - mFI（AUC：0.63）的表现相当。在9616例因GLF受伤的患者中，OFS在预测院内死亡率和FTR时与5 - mFI和11 - mFI表现相当。
在预测非脊髓损伤的手术治疗孤立性创伤性脊髓损伤患者的死亡率、并发症和未能挽救情况时，5因素改良衰弱指数和骨科衰弱评分等更简单的评分优于或等同于更复杂的衰弱评分，尤其是在老年患者和因GLF受伤的患者中。
