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

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