{
  "abstract": "Aims and Objectives Older adults account for a growing share of major trauma in the UK. Frailty, rather than age alone, is a key predictor of outcomes in trauma. It is unclear whether poorer outcomes reflect higher complication rates or less active management. Chest drains are widely used for traumatic pneumothoraces but carry risks, and practice varies. We therefore explored whether chest drain complications and treatment decisions after traumatic pneumothorax differ by frailty status using the CoMiTED cohort.Method and Design A post hoc secondary analysis of CoMiTED participants ≥65 years (‘older adult’ threshold) attending UK Emergency Departments with traumatic pneumothorax. Frailty was recorded at baseline using the Clinical Frailty Scale (CFS): non-frail (CFS 1-4) vs frail (CFS ≥5). The primary outcome was binary: ≥1 major chest drain complication within 30 days vs none, evaluated among participants who received a chest drain at any point. Major complication subcategories included chest injury-related mortality, subsequent pleural intervention (PI) and drain complications (summarised descriptively). Secondary outcomes included adherence in the drain arm and subsequent PI in the conservative arm. Proportions were reported by frailty; effect sizes were risk ratios (RR, 95% CIs). Analyses were performed in R.Abstract 4185 Table 1Primary outcome: major chest drain-related complications within 30 days of randomisation, by frailty status Non-frail (CFS 1.4)N* = 62 Frail (CFS .5)N* = 26 RR (95% CI) Any major chest drain-related complication† (.1), n (%) 13 (21.0%) 12 (46.2%) 2.20 (1.16–4.16) Chest injury-related mortality, n (%)2 (3.2%)6 (23.1%)-Received any subsequent PI, n (%)10 (16.1%)4 (15.4%)-Emergency subsequent PI, n (%)6 (9.7%)2 (7.7%)-Non-emergency subsequent PI, n (%)4 (6.5%)2 (7.7%)-Chest drain complication category:Insertional, n (%)0 (0%)1 (3.8%)-Positional, n (%)1 (1.6%)0 (0%)-Removal, n (%)2 (3.2%)0 (0%)-Infective, n (%)1 (1.6%)0 (0%)-Failure, n (%)2 (3.2%)2 (7.7%)- Effect measure: risk ratio (frail vs non-frail); 95% CI (Wald). Percentages are column percentages. The RR column is shown for the primary-outcome row only; component rows are descriptive. For the two subsequent-PI rows (emergency/non-emergency), percentages are among those with any subsequent PI. N* = participants who received a chest drain at any point during CoMiTED. † Major chest drain-related complications were prespecified and analysed as a binary outcome (≥1 event per patient). Abbreviations: CFS = Clinical Frailty Scale; RR = risk ratio; CI = confidence interval; PI = pleural intervention.Results and Conclusion Of 400 participants, 149 (37%) were aged ≥65 (mean 77.7 ± 8.6 years; male 63.8%; blunt injury 98%; falls 75.8%). Among chest drain recipients (non-frail n=62; frail n=26), frailty was associated with a higher risk of ≥1 major complication: 46.2% vs 21.0%; RR 2.20 (1.16–4.16). Adherence in the drain arm was similar by frailty (86.7% non-frail vs 83.3% frail; RR 0.96 [0.78–1.19]), as was subsequent PI in the conservative arm (40.0% vs 30.0%; RR 0.75 [0.36–1.57]).Frailty was associated with an approximately twofold higher risk of major chest drain-related complications, supporting careful risk-benefit assessment before chest drainage in frail trauma patients. Findings contextualise primary CoMiTED results to be presented at the conference.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Bristol and Weston"
      ],
      "name": "Frances Steele"
    },
    {
      "affiliations": [
        "University Hospitals Bristol and Weston"
      ],
      "name": "Olivia Mackay"
    },
    {
      "affiliations": [
        "North Bristol Trust"
      ],
      "name": "Edward Carlton"
    },
    {
      "affiliations": [
        "North Bristol Trust"
      ],
      "name": "On behalf of the CoMiTED Investigators"
    }
  ],
  "title": "4185 Frailty, intervention and outcomes in traumatic pneumothorax: a post hoc secondary analysis of the CoMiTED trial",
  "uid": "a74d72b5-5b30-52f8-9397-e1ae1ae2818d"
}