Predicting hospital discharge disposition in geriatric trauma patients: Is frailty the answer?

Bellal Joseph, Viraj Pandit, Peter Rhee, Hassan Aziz, Moutamn Sadoun, Julie Wynne, Andrew Tang, Narong Kulvatunyou, Terence OKeeffe, Mindy J. Fain, Randall S. Friese

Research output: Contribution to journalArticlepeer-review

129 Scopus citations


BACKGROUND: The frailty index (FI) has been shown to predict outcomes in geriatric patients. However, FI has never been applied as a prognostic measure after trauma. The aim of our study was to identify hospital admission factors predicting discharge disposition in geriatric trauma patients. METHODS: We performed a 1-year prospective study at our Level 1 trauma center. All trauma patients 65 years or older were enrolled. FI was calculated using 50 preadmission variables. Patient's discharge disposition was dichotomized as favorable outcome (discharge home, rehabilitation) or unfavorable outcomes (discharge to skilled nursing facility, death). Multivariate logistic regression was performed to identify factors that predict unfavorable outcome. RESULTS: A total of 100 patients were enrolled, with a mean (SD) age of 76.51 (8.5) years, 59% being males, median Injury Severity Score (ISS) of 14 (range, 9Y18), median head Abbreviated Injury Scale (h-AIS) score of 2 (2Y3), and median Glasgow Coma Scale (GCS) score of 13 (12Y15). Of the patients, 69% had favorable outcome, and 31% had unfavorable outcome. On univariate analysis, FI was found to be a significant predictor for unfavorable outcome (odds ratio, 1.8; 95% confidence interval, 1.2Y2.3). After adjusting for age, ISS, and GCS score in a multivariate regression model, FI remained a strong predictor for unfavorable discharge disposition (odds ratio, 1.3; 95% confidence interval, 1.1Y1.8). CONCLUSION: The concept of frailty can be implemented in geriatric trauma patients with similar results as those of nontrauma and nonsurgical patients. FI is a significant predictor of unfavorable discharge disposition and should be an integral part of the assessment tools to determine discharge disposition for geriatric trauma patients.

Original languageEnglish (US)
Pages (from-to)196-200
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Issue number1
StatePublished - Jan 2014
Externally publishedYes


  • Discharge disposition
  • Frailty
  • Frailty index
  • Geriatric trauma
  • Physiologic reserve

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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