Muscularity of older trauma patients at intensive care unit admission, association with functional outcomes, and relationship with frailty: A retrospective observational study

Impact of frailty in elderly patients undergoing decompressive craniectomy after traumatic brain injury

Decompressive craniectomy (DC) is a surgical procedure in which a large portion of the skull is removed and the dura mater is opened to relieve intracranial pressure. The indication in elderly patients is controversial, with prevailing studies indicating an overall poor prognosis. However, some patients recover well despite their advanced age. In this study we aimed to investigate the impact of frailty and muscularity on outcome after DC for TBI. We conducted a retrospective review of clinical notes of patients aged > 60 years, who underwent DC following TBI between January 2010 and December 2021. Temporalis muscle area (TMA) was quantified from head CT-scans upon admission. Frailty was assessed retrospectively from clinical charts using the Clinical Frailty Scale (CFS). Regression analysis were employed to determine their association with postsurgical Glasgow Outcome Scale (GOS). We identified 55 patients with a median age of 72 years (IQR 67-77; range 60-93 years). The 30-day mortality rate was 14.6%. At discharge, 32.7% of patients achieved good recovery or moderate disability (GOS 4-5), while 67.3% experienced severe disability, vegetative state, or death (GOS1-3). Initial GCS and CFS were associated to GOS at discharge in univariate (p = 0.042 and p = 0.009 respectively) and multivariate regression analysis (p = 0.049 and p = 0.013 respectively). TMA showed no association with GOS at discharge (p = 0.773). Age was associated with GOS at discharge in univariate (p = 0.042), but not multivariate linear regression (p = 0.421) when adjusted for GCS and CFS as covariables. Thirty patients (54.6%) were readmitted for cranioplasty, with 17 patients (30.9% of the entire cohort) displaying a GOS of 4-5. Frailty, rather than chronological age, emerges to be a crucial predictor of GOS following decompressive craniectomy for TBI in elderly patients. Incorporation of frailty assessment by CFS into decision-making processes could help to identify elderly patients with a more favorable post-surgical outcome, thereby facilitating treatment decisions.

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.