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Frailty has been shown in multiple studies to be a predictor of mortality, complications, and discharge disposition after major trauma (1–3). The clinical frailty scale (CFS) has a strong predictive ability in the emergency department (ED) and could be used to improve care (4–8).
There is evidence to suggest there is relatively low awareness amongst trauma providers around frailty assessment. Potential barriers include a lack of training and time to undertake the assessment (9).
This project aims to raise awareness amongst ED clinicians of the importance of measuring frailty in geriatric trauma patients in our emergency department.
‘Plan do study act’ cycles will be utilised (10). The authors will audit the use of the CFS in elderly trauma assessments in the ED prior to and between each ‘intervention.’ Interventions will include RMO teaching sessions and an article in the monthly newsletter.
Prior to the first intervention, two months worth of data showed CFS score was not documented in the ED assessment note for any patient who was later given a score by the trauma nursing team. This unfortunately did not improve following a single teaching session done at the weekly teaching.
It is clear raising awareness within the department will require a variety of interventions. The authors hope, if selected to present, they will be able to demonstrate the barriers and hopefully change following further interventions.
1. Poulton A, Shaw JF, Nguyen F, Wong C, Lampron J, Tran A, et al. The Association of Frailty With Adverse Outcomes After Multisystem Trauma: A Systematic Review and Meta-analysis. Anesth Analg [Internet]. 2020 [cited 2022 Feb 24];130(6):1482–92. Available from: https://pubmed.ncbi.nlm.nih.gov/32384338/
2. Zhao F, Tang B, Hu C, Wang B, Wang Y, Zhang L. The impact of frailty on posttraumatic outcomes in older trauma patients: A systematic review and meta-analysis. J Trauma Acute Care Surg [Internet]. 2020 Apr 1 [cited 2022 Feb 24];88(4):546–54. Available from: https://pubmed.ncbi.nlm.nih.gov/32205823/
3. Parry F, Shipway D, Thompson J, Braude P, Bouamra O, Lecky F, et al. A national study of 23 major trauma centres to investigate the effect of frailty on clinical outcomes in older people admitted with serious injury in England (FiTR 1): a multicentre observational study. Lancet Heal Longev [Internet]. 2022 Jul [cited 2022 Jul 17];0(0). Available from: http://www.thelancet.com/article/S2666756822001222/fulltext
4. Rickard F, Ibitoye S, Deakin H, Walton B, Thompson J, Shipway D, et al. The Clinical Frailty Scale predicts adverse outcome in older people admitted to a UK major trauma centre. Age Ageing [Internet]. 2021 May 5 [cited 2022 Mar 28];50(3):891–7. Available from: https://pubmed.ncbi.nlm.nih.gov/32980868/
5. Braude P, Carter B, Parry F, Ibitoye S, Rickard F, Walton B, et al. Predicting 1 year mortality after traumatic injury using the Clinical Frailty Scale. J Am Geriatr Soc [Internet]. 2022 Jan 1 [cited 2022 Jun 3];70(1):158–67. Available from: https://pubmed.ncbi.nlm.nih.gov/34624144/
6. Thompson A, Gida S, Nassif Y, Hope C, Brooks A. The impact of frailty on trauma outcomes using the Clinical Frailty Scale. Eur J Trauma Emerg Surg [Internet]. 2022 Apr 1 [cited 2022 Jun 3];48(2):1271–6. Available from: https://pubmed.ncbi.nlm.nih.gov/33682027/
7. Hamidi M, Haddadin Z, Zeeshan M, Saljuqi AT, Hanna K, Tang A, et al. Prospective evaluation and comparison of the predictive ability of different frailty scores to predict outcomes in geriatric trauma patients. J Trauma Acute Care Surg [Internet]. 2019 Nov 1 [cited 2022 Mar 27];87(5):1172–80. Available from: https://pubmed.ncbi.nlm.nih.gov/31389924/
8. Lee JH, Park YS, Kim MJ, Shin HJ, Rho YH, Kim JH, et al. Clinical frailty scale as a predictor of short-term mortality: A systematic review and meta-analysis of studies on diagnostic test accuracy. Acad Emerg Med [Internet]. 2022 Mar 29 [cited 2022 Apr 14]; Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14493
9. Shoultz TH, Moore M, Reed MJ, Kaplan SJ, Bentov I, Hough C, et al. Trauma Providers’ Perceptions of Frailty Assessment: A Mixed-Methods Analysis of Knowledge, Attitudes, and Beliefs. South Med J [Internet]. 2019 Mar 1 [cited 2022 Jul 18];112(3):159–63. Available from: https://pubmed.ncbi.nlm.nih.gov/30830229/
10. The Health Foundation. Quality improvement made simple - What everyone should know about health care quality improvement. 2021 [cited 2022 Jan 19]; Available from: https://doi.org/10.37829/HF-2021-I05