Influence of frailty on short-term mortality in older patients with multiple trauma in the emergency department

PURPOSE: To investigate the association between frailty and 28-day mortality in older patients presenting to the emergency department with multiple trauma and to assess the discriminative performance of PRISMA-7 and the Trauma-Specific Frailty Index (TSFI) in frailty assessment in relation to commonly used trauma severity scores. METHODS: This prospective observational study included patients aged ≥ 65 years with multiple trauma admitted to the emergency department between July 1 and August 31, 2024. Frailty was assessed using PRISMA-7 and TSFI. Patients were stratified into frail and non-frail groups and further categorized according to age groups (65-74, 75-84, and ≥ 85 years). Clinical characteristics, trauma severity scores, and outcomes, including 28-day mortality, were compared. Receiver operating characteristic (ROC) analysis was used to evaluate discriminative performance, and logistic regression analysis was performed to assess the association between scores and mortality. RESULTS: A total of 144 patients were included. Frailty was significantly associated with increased 28-day mortality, higher ICU admission rates, and longer hospital stays (p < 0.001). Mortality increased with age, reaching 30.0% in patients aged ≥ 85 years (p = 0.006). Frailty scores (PRISMA-7 and TSFI) increased significantly with age, whereas ISS did not differ significantly across age groups. ROC analysis demonstrated comparable discriminative performance among scoring systems, with PRISMA-7 showing balanced sensitivity and specificity. In logistic regression analysis, all scores were significantly associated with mortality, and frailty identified by PRISMA-7 was associated with a higher mortality risk. CONCLUSION: Frailty is significantly associated with adverse outcomes, including increased mortality, in older trauma patients. Frailty assessment using simple screening tools such as PRISMA-7 may complement traditional trauma severity scores and help identify high-risk patients in emergency settings.