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Prognostic Value of Frailty for Outcome Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis Publisher Pubmed



Roohollahi F1, 2 ; Molavi S1 ; Mohammadi M3 ; Mohamadi M3 ; Mohammadi A3 ; Kankam SB1, 2, 4 ; Farahbakhsh F4 ; Moarrefdezfouli A4 ; Peters ME5 ; Albrecht JS6 ; Gardner RC7 ; Rahimimovaghar V4
Authors
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Authors Affiliations
  1. 1. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  4. 4. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
  6. 6. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
  7. 7. Department of Neurology, University of California San Francisco, San Francisco, CA, United States

Source: Journal of Neurotrauma Published:2024


Abstract

Frailty is a known predictor of negative health outcomes. The role of frailty in predicting outcomes after traumatic brain injury (TBI), however, is unclear. This systematic review aimed to evaluate the association between frailty and adverse outcomes in patients with TBI. We identified relevant articles that investigated the relationship between frailty and outcomes in patients with TBI by searching PubMed/MEDLINE, Web of Science, Scopus, and EMBASE from inception until 23 March 2023. To evaluate the risk of bias in the included studies, we utilized the Newcastle-Ottawa Scale (NOS). In addition, quantitative synthesis and meta-analyses were performed. We identified 12 studies that met our inclusion criteria; three were prospective. Of included studies, eight had low risk, three had moderate risk, and one had high risk of bias. Frailty was significantly associated with death in five studies, with an increased risk of in-hospital death and complications observed in frail patients. Frailty was associated with longer hospital stays and unfavorable outcome measured by the Extended Glasgow Outcome Scale (GOSE) in four studies. The meta-analysis found that higher frailty significantly increased the odds of non-routine discharge and unfavorable outcome as measured by GOSE scores of 4 or lower. The pooled odds ratio (OR) for non-routine discharge, was 1.80, with a 95% confidence interval (CI) of 1.15–2.84; and for unfavorable outcome, it was 1.91, with a 95% CI of 1.09-3.36. The analysis, however, did not find a significant predictive role for frailty on death (30-day or in-hospital death). The OR for higher frailty and death was 1.42 with a 95% CI of 0.92–2.19. Frailty should be considered in the evaluation of patients with TBI to identify those who may be at increased risk of negative outcomes. © 2024 Mary Ann Liebert Inc.. All rights reserved.
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