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Alqarni, Abdullah (2024) The prognostic value of frailty in major trauma in older people. PhD thesis, University of Nottingham.

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Abstract

Background: The incidence of major trauma in older people is rising. Frailty significantly raises the probability of poor trauma outcomes in older people. The purpose of this thesis is to investigate the predictive value of frailty in major trauma as well as to determine the need for developing a frailty evaluation instrument specifically for older individuals who have had major trauma.

Methods: An overview and review of relevant literature concerning frailty and major trauma in older people was conducted. A systematic review and meta-analysis were undertaken to investigate the frailty concept's influence on the outcomes of older trauma patients. A trauma frailty index was created as a tool for diagnosing frailty in older people who had experienced trauma using routinely collected data. The index was verified against adverse outcomes using two samples in and out of sample data sets to prove its relevance and validity in a larger population of trauma patients. Two further validations were conducted to determine the index's ideal threshold for the development of adverse outcomes.

Results: Frailty status in older persons with major trauma was linked to higher in-patient mortality, duration of hospital stay, discharge location, and comorbidities. Frailty was consistently a better predictor of death and unfavourable discharge location than age or injury severity. Frailty detection methods do not seem to be suitable for use with traumatically injured older people. The Nottingham Trauma Frailty Index (NTFI) has identified five variables that strongly predict frailty (regression coefficient B = 6.383 (95% confidence interval 5.03 to 7.74), p < 0.001): age, Abbreviated Mental Test score, admission haemoglobin concentration (g/l), pre-admission mobility (requiring assistance or not), and mechanism of injury (falls from standing height). During validation, there was a strong agreement between the NTFI and the CFS (mean difference 0.02), with no obvious systematic bias. In two validations against clinical outcomes, growing NTFI was related to adverse outcomes that included in-hospital complications, adverse discharge destinations, the increase in dependency level, and length of stay. NTFI ≥ 4.345 was a significant predictive threshold for adverse outcomes including discharge to rehabilitation unit, discharge to nursing care home, discharge to residential care home, mortality, increase in dependency level, and in-hospital complications.

Conclusion: The frailty state of older trauma patients is a better predictor of poor outcomes than their age or injury severity score. The NTFI has shown a noteworthy performance in predicting clinical outcomes in both in-sample and out-of-sample data sets. The NTFI is a practical tool that clinicians and researchers may use to direct patient care and analyse quality improvement and research initiatives. It utilises readily and regularly recorded physiological and functional characteristics.

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Ollivere, Benjamin Gladman, John
Keywords:	Frailty; Traumatic injuries; Aged; Clinical outcomes
Subjects:	W Medicine and related subjects (NLM Classification) > WT Geriatrics. Chronic disease
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID:	79406
Depositing User:	Alqarni, Abdullah
Date Deposited:	15 Oct 2024 04:40
Last Modified:	15 Oct 2024 04:40
URI:	https://eprints.nottingham.ac.uk/id/eprint/79406

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