Ting-Hway Wong1, Timothy Xin Zhong Tan2, Rahul Malhotra3, Nivedita V Nadkarni4, Wei Chong Chua5, Lynette Ma Loo6, Philip Tsau Choong Iau6, Arron Seng Hock Ang7, Jerry Tiong Thye Goo8, Kim Chai Chan9, David Bruce Matchar3, Dennis Chuen Chai Seow10, Hai V Nguyen11, Yee Sien Ng12, Angelique Chan13, Stephanie Fook-Chong3, Tjun Yip Tang14, Marcus Eng Hock Ong15. 1. Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore; Department of General Surgery, Singapore General Hospital, Singapore. 2. Department of Emergency Medicine, Singapore General Hospital, Singapore. Electronic address: timothy.tbj13@gmail.com. 3. Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore. 4. Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore. 5. Trauma Service, Tan Tock Seng Hospital, Singapore. 6. Department of General Surgery, National University Hospital, Singapore. 7. Accident & Emergency, Changi General Hospital, Singapore. 8. Department of General Surgery, Khoo Teck Puat Hospital, Singapore. 9. Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore. 10. Department of Geriatric Medicine, Singapore General Hospital, Singapore. 11. School of Pharmacy, Memorial University of Newfoundland, Canada, St. John's, Newfoundland, Canada. 12. Department of Rehabilitation Medicine, Singapore General Hospital, Singapore. 13. Centre for Ageing Research and Education, Duke-NUS Graduate Medical School, Singapore. 14. Department of Vascular Surgery, Singapore General Hospital, Singapore. 15. Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore.
Abstract
OBJECTIVE: Frailty is associated with morbidity and mortality in older injured patients. However, for older blunt-trauma patients, increased frailty may not manifest in longer length of stay at index admission. We hypothesized that owing to time spent in hospital from readmissions, frailty would be associated with less total time at home in the 1-year postinjury period. DESIGN: Prospective, nationwide, multicenter cohort study. SETTING AND PARTICIPANTS: All Singaporean residents aged ≥55 years admitted for blunt trauma with an Injury Severity Score (ISS) or New Injury Severity Score (NISS) ≥10 from March 2016 to July 2018. METHODS: Frailty (by modified Fried criteria) was assessed at index admission, based on questions on preinjury weight loss, slowness, exhaustion, physical activity, and grip strength at the time of recruitment. Low time at home was defined as >14 hospitalized days within 1 year postinjury. The contribution of planned and unplanned readmission to time at home postinjury was explored. Functional trajectory (by Barthel Index) over 1 year was compared by frailty. RESULTS: Of the 218 patients recruited, 125 (57.3%) were male, median age was 72 years, and 48 (22.0%) were frail. On univariate analysis, frailty [relative to nonfrail: odds ratio (OR) 3.45, 95% confidence interval (CI) 1.33-8.97, P = .01] was associated with low time at home. On multivariable analysis, after inclusion of age, gender, ISS, intensive care unit admission, and surgery at index admission, frailty (OR 5.21, 95% CI 1.77-15.34, P < .01) remained significantly associated with low time at home in the 1-year postinjury period. Unplanned readmissions were the main reason for frail participants having low time at home. Frail participants had poorer function in the 1-year postinjury period. CONCLUSIONS AND IMPLICATIONS: In the year following blunt trauma, frail older patients experience lower time at home compared to patients who were not frail at baseline. Screening for frailty should be considered in all older blunt-trauma patients, with a view to being prioritized for postdischarge support.
OBJECTIVE: Frailty is associated with morbidity and mortality in older injured patients. However, for older blunt-trauma patients, increased frailty may not manifest in longer length of stay at index admission. We hypothesized that owing to time spent in hospital from readmissions, frailty would be associated with less total time at home in the 1-year postinjury period. DESIGN: Prospective, nationwide, multicenter cohort study. SETTING AND PARTICIPANTS: All Singaporean residents aged ≥55 years admitted for blunt trauma with an Injury Severity Score (ISS) or New Injury Severity Score (NISS) ≥10 from March 2016 to July 2018. METHODS: Frailty (by modified Fried criteria) was assessed at index admission, based on questions on preinjury weight loss, slowness, exhaustion, physical activity, and grip strength at the time of recruitment. Low time at home was defined as >14 hospitalized days within 1 year postinjury. The contribution of planned and unplanned readmission to time at home postinjury was explored. Functional trajectory (by Barthel Index) over 1 year was compared by frailty. RESULTS: Of the 218 patients recruited, 125 (57.3%) were male, median age was 72 years, and 48 (22.0%) were frail. On univariate analysis, frailty [relative to nonfrail: odds ratio (OR) 3.45, 95% confidence interval (CI) 1.33-8.97, P = .01] was associated with low time at home. On multivariable analysis, after inclusion of age, gender, ISS, intensive care unit admission, and surgery at index admission, frailty (OR 5.21, 95% CI 1.77-15.34, P < .01) remained significantly associated with low time at home in the 1-year postinjury period. Unplanned readmissions were the main reason for frail participants having low time at home. Frail participants had poorer function in the 1-year postinjury period. CONCLUSIONS AND IMPLICATIONS: In the year following blunt trauma, frail older patients experience lower time at home compared to patients who were not frail at baseline. Screening for frailty should be considered in all older blunt-trauma patients, with a view to being prioritized for postdischarge support.
Authors: Ting-Hway Wong; Timothy Xin Zhong Tan; Lynette Ma Loo; Wei Chong Chua; Philip Tsau Choong Iau; Arron Seng Hock Ang; Jerry Tiong Thye Goo; Kim Chai Chan; Hai V Nguyen; Nivedita V Nadkarni; David Bruce Matchar; Dennis Chuen Chai Seow; Yee Sien Ng; Angelique Chan; Stephanie Fook-Chong; Tjun Yip Tang; Marcus Eng Hock Ong; Rahul Malhotra Journal: PLoS One Date: 2022-10-10 Impact factor: 3.752