Predictive ability of frailty scores in surgically managed patients with traumatic spinal injuries: a TQIP analysis

European Journal of Trauma and Emergency Surgery, 2025 · DOI: 10.1007/s00068-025-02775-0 · Published: January 25, 2025

Simple Explanation

This study compares how well different frailty scores predict outcomes for patients with traumatic spinal injuries (TSI) who undergo surgery, excluding those with spinal cord injuries. The study looked at the Orthopedic Frailty Score (OFS), Hospital Frailty Risk Score (HFRS), and modified frailty indices (5-mFI and 11-mFI), along with the Johns Hopkins Frailty Indicator. The findings suggest that simpler frailty scores, like the 5-mFI and OFS, are as good as or better than more complex scores in predicting mortality and complications, especially for older patients and those injured from ground-level falls.

Study Duration

2013-2021

Participants

39,449 adult patients with isolated traumatic spinal injury

Evidence Level

Not specified

Key Findings

1
The 5-mFI and 11-mFI outperformed other scores in predicting in-hospital mortality, any complication, and failure-to-rescue (FTR).
2
Among geriatric patients, the OFS showed the highest predictive ability for in-hospital mortality and performed comparably to 5-mFI and 11-mFI for predicting FTR.
3
In patients injured due to ground-level falls, the OFS performed on par with 5-mFI and 11-mFI in predicting in-hospital mortality and FTR.

Research Summary

This study evaluated the predictive ability of various frailty scores for adverse outcomes in surgically managed isolated traumatic spinal injury (TSI) patients without spinal cord injury. Simpler frailty scores, such as the 5-factor modified Frailty Index (5-mFI) and Orthopedic Frailty Score (OFS), performed as well as or better than more complex scores in predicting mortality, complications, and failure-to-rescue. The simpler scores were particularly effective among geriatric patients and those injured in ground-level falls, suggesting that complex frailty assessments may not always be necessary for predicting outcomes in these populations.

Practical Implications

Efficient Frailty Assessment

Simpler frailty scores can be used for quick and straightforward frailty assessments, enhancing usability in clinical settings.

Personalized Treatment Decisions

Frailty assessments can inform personalized treatment decisions, such as considering conservative surgical options for frail patients.

Informed Shared Decision-Making

Frailty assessments provide evidence-based estimates of potential outcomes, supporting shared decision-making between healthcare providers and patients.

Study Limitations

1
The study's retrospective design presents potential for selection bias and misclassification.
2
The study was constrained by the variables available in the TQIP database, limiting the inclusion of other established frailty scores.
3
The study could not evaluate the predictive ability of the included scores for additional outcomes of interest such as readmission rates, quality of life, long-term mortality, and long-term functional outcomes.

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