The Low Fall as a Surrogate Marker of Frailty Predicts Long-Term Mortality in Older Trauma Patients

• Published in: PloS one 2015-09, Vol.10 (9), p.e0137127-e0137127
• Main Authors: Wong, Ting Hway, Nguyen, Hai V, Chiu, Ming Terk, Chow, Khuan Yew, Ong, Marcus Eng Hock, Lim, Gek Hsiang, Nadkarni, Nivedita Vikas, Bautista, Dianne Carrol Tan, Cheng, Jolene Yu Xuan, Loo, Lynette Mee Ann, Seow, Dennis Chuen Chai
• Format: Article
• Language: English
• Subjects: Accidental Falls - mortality; Adults; Age; Age factors; Aged; Aged, 80 and over; Aging; Biomarkers; Body height; Comorbidity; Elderly patients; Emergency medical services; Emergency Service, Hospital; Epidemiology; Falls; Female; Females; Fractures; Fractures, Bone - mortality; Frailty; Gender differences; Hip; Hospital emergency services; Humans; Injuries; Injury analysis; Injury Severity Score; Logistic Models; Male; Males; Management; Middle Aged; Mortality; Older people; Patients; Psychological aspects; Registries; Regression analysis; Risk; Sensitivity analysis; Singapore; Trauma; Trauma Centers; Wounds, Nonpenetrating - mortality
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0137127

Frailty is associated with adverse outcomes including disability, mortality and risk of falls. Trauma registries capture a broad range of injuries. However, frail patients who fall comprise a large proportion of the injuries occurring in ageing populations and are likely to have different outcomes compared to non-frail injured patients. The effect of frail fallers on mortality is under-explored but potentially significant. Currently, many trauma registries define low falls as less than three metres, a height that is likely to include non-frailty falls. We hypothesized that the low fall from less than 0.5 metres, including same-level falls, is a surrogate marker of frailty and predicts long-term mortality in older trauma patients. Using data from the Singapore National Trauma Registry, 2011-2013, matched till September 2014 to the death registry, we analysed adults aged over 45 admitted via the emergency department in public hospitals sustaining blunt injuries with an injury severity score (ISS) of 9 or more, excluding isolated hip fractures from same-level falls in the over 65. Patients injured by a low fall were compared to patients injured by high fall and other blunt mechanisms. Logistic regression was used to analyze 12-month mortality, controlling for mechanism of injury, ISS, revised trauma score (RTS), co-morbidities, gender, age and age-gender interaction. Different low fall height definitions, adjusting for injury regions, and analyzing the entire adult cohort were used in sensitivity analyses and did not change our findings. Of the 8111 adults in our cohort, patients who suffered low falls were more likely to die of causes unrelated to their injuries (p