Early predictors for long-term functional outcome after mild traumatic brain injury in frail elderly patients

Amaal Eman Abdulle, Myrthe E. de Koning, Harm J. van der Horn, Myrthe E. Scheenen, Gerwin Roks, Gerard Hageman, Jacoba M. Spikman, Joukje van der Naalt

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Objective: To identify the effect of frailty and early post injury measures on the long-term outcome after mild traumatic brain injury in elderly patients.
Setting: Patients admitted to 3 Dutch hospitals designated as level 1 trauma centers.
Participants: The elderly (≥60 years) with mild traumatic brain injury (N = 161). Design: A prospective observational cohort study.
Main Measures: Post traumatic complaints and the Hospital Anxiety and Depression Scale determined 2 weeks post injury; the Glasgow Outcome Scale Extended and Groningen frailty indicator determined 1 to 3 years post injury. Results: A total of 102 non frail (63%) and 59 frail elderly (37%)patients, mean age of 70.8 (6.3) years were included. Most patients (54%; 72% non frail and 24% frail) recovered completely 1 to 3 years post injury. Two weeks post injury, 81% had post traumatic complaints (83% frail and 80% non frail elderly), and 30% showed emotional distress (50% frail and 20% non frail). Frailty (odds ratio, 2.1; 95%confidence interval, 1.59-2.77) and presence of early complaints (odds ratio, 1.13; 95% confidence interval, 1.01-1.27) (Nagelkerke R2 = 46%) were found to predict long-term outcome, whereas age was not a significant predictor.
Conclusion: The frail elderly had worse long-term outcome, and early complaints were found to be a stronger predictor of unfavorable outcome than age. Understanding the implications of frailty on outcome could help clinicians recognize patients at risk of a poor outcome and allocate care more efficiently. Key words: aging, brain injuries, depression, follow-up studies, frail elderly, outcome assessment (healthcare), prognosis, rehabilitation
Original languageEnglish
Pages (from-to)E59–E67
Number of pages9
JournalJournal of Head Trauma Rehabilitation
Issue number6
Publication statusPublished - 2018


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