Predictive ability of frailty scores in surgically managed patients with traumatic spinal injuries without spinal cord injury: A TQIP analysis

Introduction

There are numerous frailty scores available today; however, there is a paucity in evidence regarding which are the best to use in specific patient populations. The aim of the current investigation was therefore to compare the ability of several frailty scores to predict adverse outcomes in traumatic spinal injury (TSI) patients.

Material & Methods

All adult patients (18 years or older) who suffered an isolated TSI due to blunt trauma, and required surgical management, were extracted from the 2013-2021 Trauma Quality Improvement Program database. The ability of the Orthopedic Frailty Score (OFS), the Hospital Frailty Risk Score (HFRS), the 11-factor (11-mFI) and 5-factor (5-mFI) modified frailty index, as well as the Johns Hopkins Frailty Indicator to predict adverse outcomes was compared based on the area under the receiver-operating characteristic curve (AUC).

Results

39,449 patients were selected from the TQIP database. The 5-mFI and 11-mFI outperformed all other frailty scores when predicting in-hospital mortality [5-mFI AUC (95% CI): 0.73 (0.71-0.75)] [11-mFI AUC (95% CI): 0.73 (0.71-0.75)], any complication [5-mFI AUC (95% CI): 0.65 (0.64-0.66)] [11-mFI AUC (95% CI): 0.65 (0.64-0.66)], and FTR [5-mFI AUC (95% CI): 0.75 (0.73-0.78)] [11-mFI AUC (95% CI): 0.75 (0.73-0.78)]. Among the 14,257 geriatric patients, however, the OFS demonstrated the highest predictive ability for in-hospital mortality [AUC (95% CI): 0.65 (0.62-0.67)]. The OFS [AUC (95% CI): 0.64 (0.61-0.67)] also performed on the same level as both the 5-mFI [AUC (95% CI): 0.63 (0.60-0.66)] and the 11-mFI [AUC (95% CI): 0.63 (0.60-0.66)] when predicting FTR in this population.

Conclusions

Simpler scores like the 5-factor modified frailty index and Orthopedic Frailty Score outperform or perform on par with more complicated frailty scores when predicting mortality, complications, and failure-to-rescue in traumatic spinal injury patients, particularly among geriatric patients.

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