891 Age and Ageing 2021; 50: 891–897 doi: 10.1093/ageing/afaa180 Published electronically 25 September 2020 © The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions,please email: journals.permissions@oup.com RESEARCH PAPER The Clinical Frailty Scale predicts adverse outcome in older people admitted to a UK major trauma centre Frances Rickard 1 , Sarah Ibitoye 1 , Helen Deakin 1 ,Benjamin Walton 2 , Julian Thompson 2 , David Shipway 3,4 , Philip Braude 3 1 Clinical Fellow in Geriatric Trauma, North Bristol NHS Trust, Bristol, UK 2 Consultant in Critical Care Medicine & Anaesthetics, North Bristol NHS Trust, Bristol, UK 3 Consultant Physician and Perioperative Geriatrician, North Bristol NHS Trust, Bristol, UK 4 Honorary Senior Clinical Lecturer, University of Bristol, Bristol, UK Address correspondence to: Frances Rickard, Southmead Hospital, North Bristol Trust, Southmead Road, Bristol, BS10 5NB UK. Tel: 0117 414 6643. Email: rickard.fh@gmail.com. Abstract Background: Frailty assessment using the Clinical Frailty Scale (CFS) has been mandated for older people admitted to English major trauma centres (MTC) since April 2019. Little evidence is available as to CFS-associated outcomes in the trauma population. Objective: To investigate post-injury outcomes stratified by the CFS. Methods: A single centre prospective observational cohort study was undertaken. CFS was prospectively assigned to patients ≥ 65 years old admitted to the MTC over a 5-month period. Primary outcome was 30-day post-injury mortality. Secondary outcomes were length of hospital stay, complications and discharge level of care. Results: In 300 patients median age was 82; 146 (47%) were frail (CFS 5–9) and 28 (9.3%) severely frail (CFS 7–9). Frail patients had lower injury severity scores (median 9 vs 16) but greater 30-day mortality (CFS 5–6 odds ratio (OR) 5.68; P < 0.01; CFS 7–9 OR 10.38; P < 0.01). Frailty was associated with delirium (29.5% vs 17.5%; P = 0.02), but not complication rate (50.7% vs 41.6%; P = 0.20) or length of hospital stay (13 vs 11 days; P = 0.35). Mild to moderate frailty was associated with increased care level at discharge (OR 2.31; P < 0.01). Conclusions: Frailty is an independent predictor of 30-day mortality, inpatient delirium and increased care level at discharge in older people experiencing trauma. CFS can therefore be used to identify those at risk of poor outcome who may benefit from comprehensive geriatric review, validating its inclusion in the 2019 best practice tariff for major trauma. Keywords: older people, frailty, trauma, mortality, care level at discharge, Clinical Frailty Scale Key Points • Frailty using Clinical Frailty Scale (CFS) is associated with increased 30-day mortality, delirium rate, and level of care required on discharge. • CFS can be used to identify older adults at risk of poor outcome following admission with trauma. • Tis research validates the inclusion of CFS in the 2019 best practice tariff for major trauma. • Further research is required to determine if trauma patients with frailty benefit from comprehensive geriatric assessment. Downloaded from https://academic.oup.com/ageing/article/50/3/891/5911169 by guest on 19 December 2022