Frailty Index Predicts Withdrawal of Life-Sustaining Therapy in Geriatric Patients With Rib Fractures

Geriatric patients with rib fractures have a high morbidity and mortality. The 5-item-modified frailty index (mFI-5) is associated with increased complications and mortality in trauma patients. We aim to determine predictors of withdrawal of life-sustaining therapy (WDLST) in geriatric patients with rib fractures.

Patients were stratified by WDLST and compared. We conducted a multivariable logistic regression (MLR) to determine predictors of WDLST.

A total of 4707 patients were included, 92 (2%) patients underwent WDLST. MLR found history of advanced directive and injury severity score are associated with WDLST. On MLR, mFI-5 score of >0.4 (adjusted odds ratio = 2.55, 95% confidence interval 1.31-4.96, P = 0.006), which is equivalent to having >2 risk factors, was associated with WDLST. The WDLST cohort had higher mortality (88% versus 1%, P < 0.0001).

The severity of injury and older age are associated with WDLST. The mFI-5 is a tool that may be useful to obtain earlier palliative care intervention.