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Frailty Index Predicts Withdrawal of Life-Sustaining Therapy in Geriatric Patients With Rib Fractures.
Reid Bartholomew1, Jeffery Nelson2, Saskya Byerly2
1Department of Surgery, Wayne Health, Detroit, Michigan; Department of Surgery, Detroit Medical Center, Detroit, Michigan.
The Journal of Surgical Research
|January 20, 2026
Summary
Geriatric patients with rib fractures undergoing withdrawal of life-sustaining therapy (WDLST) were predicted by injury severity and frailty. The modified frailty index (mFI-5) may aid early palliative care for elderly trauma patients.
Area of Science:
- Geriatric Trauma
- Palliative Care
- Clinical Predictors
Background:
- Geriatric patients with rib fractures face high morbidity and mortality.
- The 5-item-modified frailty index (mFI-5) correlates with adverse outcomes in trauma.
- Predictors for withdrawal of life-sustaining therapy (WDLST) in this population are not well-defined.
Purpose of the Study:
- To identify predictors of WDLST in geriatric patients with rib fractures.
- To evaluate the association between the mFI-5 and WDLST.
Main Methods:
- Retrospective analysis of 4707 geriatric patients with rib fractures.
- Stratification of patients based on WDLST.
- Multivariable logistic regression (MLR) to determine WDLST predictors.
Main Results:
- 92 (2%) patients underwent WDLST.
- History of advanced directive and injury severity score were associated with WDLST.
- An mFI-5 score >0.4 (indicating >2 risk factors) was significantly associated with WDLST (aOR=2.55, P=0.006).
- The WDLST cohort exhibited substantially higher mortality (88% vs 1%).
Conclusions:
- Injury severity and advanced age are linked to WDLST in geriatric rib fracture patients.
- The mFI-5 can serve as a valuable tool for early palliative care interventions.
- WDLST is associated with significantly increased mortality in this cohort.
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