Association of Frailty, Comorbidities and Muscularity With GOS and 30-Day Mortality After TBI in Elderly Patients—A Retrospective Study in 1104 Patients

OBJECTIVE: This study aimed to assess the prognostic value of various frailty assessment tools in predicting 30-day mortality and Glasgow outcome scale (GOS) at discharge in elderly patients with traumatic brain injury (TBI). Additionally, the study evaluated the role of muscularity as surrogate for frailty in the context of TBI. SETTING: Data were collected from patients treated as inpatients in a single hospital. PARTICIPANTS: All patients aged 60 years or older who were admitted for TBI between 1/2010 and 12/2020. DESIGN: A single-center study, with retrospective analysis of clinical notes and computed tomography (CT) imaging at admission. MEAN MEASURES: Assessment of frailty by different frailty grading scales, comorbidities by the Charlson Comorbidity Index (CCI), assessment of muscularity by muscle area measurements and their association with outcome of TBI. RESULTS: A total of 1104 patients with a median age of 78 years (IQR 72-84) were identified. The overall mortality rate was 12.9% (n = 137). Multivariate regression models identified frailty measured by the Clinical Frailty Scale (CFS) ( P < .0001) as predictive variable for short-term mortality and the CCI as predictive variable for GOS at discharge ( P = .009); muscle area measurements as surrogate markers of sarcopenia were not associated with outcome in our cohort. Implementing frailty as measured by CFS and CCI into prognostic models for short-term mortality increased their predictive power (increase of area under the ROC curve from 0.897 to 0.919). CONCLUSIONS: Geriatric-specific models are necessary for a more accurate prognosis estimation of elderly patients with TBI. Our findings suggest that frailty measured by CFS and assessment of comorbidities by CCI adds prognostic value, while muscularity at various locations (as assessed in CT imaging) had no effect on 30-day mortality after TBI.