Multidimensional Preinjury Health and 6-month Outcome After Traumatic Brain Injury in Older Adults Presenting With Mainly GCS 13-15.
Roy Tzemah-Shahar, Yael Rosen Lang, Ava M Puccio and 10 others
PMID 42661255WHAT IT FOUND
Adding pre-injury frailty and daily-function measures to existing prediction models did not improve prediction in older adults with mostly mild traumatic brain injury, although the measures were linked to worse 6-month recovery.
Key findings
01CRASH-basic was the best of the four existing models for predicting 6-month severe disability or death, with an AUC of 0.74, considered fair.
02Adding pre-injury measures did not produce a statistically significant improvement in prediction (all DeLong p>0.05).
03GFI and FAQ were independently associated with greater odds of poor 6-month outcome, while CCI was not.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The model optimization analysis included only 103 participants, and the authors say limited power may explain the lack of significant model improvement. Only 160 of 270 planned participants completed the main outcome (59%), and missing data and attrition may leave residual selection bias. Most participants had GCS 13-15, with low enrollment of GCS<13, so results do not extend well to moderate or severe older-adult TBI. GOSE<5 may be unstable in older adults with high pre-existing disability because small absolute changes in function can cause large GOSE changes. Without a non-TBI trauma control group, the study cannot separate intracranial injury decline from hospitalization or other trauma effects. The CRASH and IMPACT models were not refitted to this cohort; published coefficients were used as single predictors because of small sample size.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that the FAQ or GFI should guide individual patient care. Adding them to the prediction model did not significantly improve prediction, and the authors state these findings should not yet guide individual patient care.