The Geriatric Patient One Year After Trauma: Palliative Performance Scale Predicts Functional Outcomes

Michele Fiorentino; Franchesca Hwang; Sri Ram Pentakota; Nina E Glass; David H Livingston; Anne C Mosenthal

doi:10.1016/j.injury.2023.110957

The Geriatric Patient One Year After Trauma: Palliative Performance Scale Predicts Functional Outcomes

Injury. 2023 Sep;54(9):110957. doi: 10.1016/j.injury.2023.110957. Epub 2023 Jul 23.

Authors

Michele Fiorentino¹, Franchesca Hwang², Sri Ram Pentakota², Nina E Glass², David H Livingston², Anne C Mosenthal²

Affiliations

¹ Rutgers New Jersey Medical School, 185 South Orange Avenue, Medical Science Building, Room G 594, Newark, NJ 07101. Electronic address: michele.n.fiorentino@vumc.org.
² Rutgers New Jersey Medical School, 185 South Orange Avenue, Medical Science Building, Room G 594, Newark, NJ 07101.

PMID: 37532666
DOI: 10.1016/j.injury.2023.110957

Abstract

Introduction: Frailty in trauma has been found to predict poor outcomes after injury including additional in-hospital complications, mortality, and discharge to dependent care. These gross outcome measures are insufficient when discussing long-term recovery as they do not address what is important to patients including functional status and quality of life. The purpose of this study is to determine if the Palliative Performance Scale (PPS) predicts mortality and functional status one year after trauma in geriatric patients.

Material and methods: Prospective observational study of trauma survivors, age ≥55 years. Patients were stratified by pre-injury PPS high (>70) or low (≤70). Outcomes were functional status at 1 year measured by Glasgow Outcome Scale Extended (GOSE), Euroqol-5D and SF-36. Adjusted relative risks (aRR) were obtained using modified Poisson regression.

Results: Follow-up was achieved on 215/301 patients. Mortality was 30% in low PPS group vs 8% in the high PPS group (P<0.001). A greater percentage of patients in the high group had a good functional outcome at one year compared to patients in the low group (78% vs 30% p<0.001). The high PPS patients were more likely to have improvement of GOSE at 1 year from discharge compared to low group (66% vs 27% P<0.001). Low PPS independently predicted poor functional outcome (aRR, 2.64; 95% confidence interval, 1.79-3.89) and death at 1 year (aRR, 3.64; 95% confidence interval 1.68-7.92). An increased percentage of low PPS patients reported difficulty with mobility (91% vs 46% p<0.0001) and usual activities (82% vs 56% p=0.002). Both groups reported pain (65%) and anxiety/depression (47%).

Conclusion: Low pre-Injury PPS predicts mortality and poor functional outcomes one year after trauma. Low PPS patients were more likely to decline, rather than improve. Regardless of PPS, most patients have persistent pain, anxiety, and limitations in performing daily activities.

Keywords: Frailty; Geriatric trauma; Goals of care; Long term outcomes; Surgical Palliative care.

Publication types

Observational Study

MeSH terms

Aged
Glasgow Outcome Scale
Humans
Middle Aged
Outcome Assessment, Health Care*
Pain
Prospective Studies
Quality of Life*