Comparing How Three Frailty Scales Predict Negative Outcomes in Trauma Patients With Rib Fractures

Area of Science:

• Geriatric Trauma
• Clinical Epidemiology
• Predictive Analytics in Healthcare

Background:

• Frailty is a significant risk factor for adverse outcomes in injured older adults.
• Accurate frailty assessment is crucial for predicting patient trajectories after trauma.

Purpose of the Study:

• To compare the predictive performance of three distinct frailty scales in older patients (≥65 years) admitted with rib fractures.
• To determine the most applicable frailty scale for identifying negative outcomes in this population.

Main Methods:

• Retrospective analysis of 341 patients (≥65 years) with rib fractures.
• Frailty assessment using the Canadian Study of Health and Aging clinical frailty scale, rib fracture frailty index (RFFI), and modified frailty index-5.
• Evaluation of outcomes including mortality, pneumonia, intubation, length of stay, and discharge disposition; statistical analysis of predictive abilities and interrater agreement (Fleiss' Kappa).

Main Results:

• All three frailty scales demonstrated comparable predictive abilities for adverse outcomes.
• The RFFI showed 70% accuracy in predicting mortality and pneumonia.
• All scales achieved 60% accuracy in predicting discharge to skilled nursing facilities.
• Fair to moderate agreement (Fleiss' Kappa = 0.40) was observed among the scales.
• Predictive performance was notably higher in the 65-74 year age group compared to those ≥75 years.

Conclusions:

• No single frailty assessment scale demonstrated statistically significant superiority in predicting adverse outcomes for older adults with rib fractures based on AUC analysis.
• Interrater reliability of the assessed frailty scales was higher in younger elderly individuals (65-74 years) than in the oldest old (≥75 years).