This study aimed to evaluate the utility of the 11-variable modified Frailty Index (mFI) in prognosticating elderly patients with traumatic acute subdural hematomas (aSDHs). A state-service level 1 trauma center registry was interrogated to investigate consecutive patients ≥65 years of age presenting with traumatic aSDH, with or without major extracranial injury, between January 2013 and December 2017. mFI on admission, demographics, and admission details, including Glasgow Coma Scale (GCS) and pupillary status and radiological findings, were retrospectively retrieved from institutional records. Clinical outcome data were retrieved from medical records and the Victorian State Trauma Registry (VSTR). Outcome measures were 1) 30-day mortality and 2) 6-month unfavorable outcome, defined by the Extended Glasgow Outcome Scale (GOS-E). Five hundred twenty-nine consecutive cases were identified from the registry. Demographic data included: 1) age (median; interquartile range) = 80.46; 74.17–85.89; 2) mFI (mean ± standard deviation) = 1.96 ± 1.42 of 11 variables. Four hundred sixteen cases (79%) had complete outcome data. As mFI increased from 0/11 variables to ≥5/11 variables (≥0.45), 30-day mortality risk increased from 17.72% to 39.29% (p = 0.023) and 6-month unfavorable outcome risk increased from 40.51% to 96.43% (p < 0.001). Multi-variate analysis showed that greater mFI score of ≥3/11 variables (≥0.27) suggested a significantly higher risk of 30-day mortality (p = 0.009) and unfavorable outcome (p < 0.001). We conclude that increasing frailty, as measured by the mFI, was associated with significantly higher risk of 30-day mortality and 6-month unfavorable outcome in elderly patients presenting with aSDH to a level 1 neurotrauma center. Assessment of mFI in elderly patients with aSDH may be a useful determinant of outcome for this rapidly growing population.

中文翻译：

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改良虚弱指数在老年急性外伤性硬膜下血肿预后预测中的应用。

本研究旨在评估 11 变量修正虚弱指数 (mFI) 在预测患有外伤性急性硬膜下血肿 (aSDH) 的老年患者中的效用。2013 年 1 月至 2017 年 12 月期间，国家服务 1 级创伤中心登记处被询问，以调查连续 65 岁以上出现创伤性 aSDH 的患者，有或没有严重的颅外损伤。 mFI 入院、人口统计和入院详细信息，包括格拉斯哥昏迷量表 (GCS) 和瞳孔状态和放射学发现，是从机构记录中追溯检索的。从医疗记录和维多利亚州创伤登记处 (VSTR) 中检索临床结果数据。结局指标为 1) 30 天死亡率和 2) 6 个月不利结局，由扩展格拉斯哥结局量表 (GOS-E) 定义。从登记处确定了 529 个连续病例。人口统计数据包括：1) 年龄（中位数；四分位距）= 80.46；74.17–85.89；2) mFI（平均值 ± 标准偏差）= 11 个变量的 1.96 ± 1.42。416 例 (79%) 具有完整的结果数据。随着 mFI 从 0/11 变量增加到≥5/11 变量（≥0.45），30 天死亡风险从 17.72% 增加到 39.29%（p  = 0.023)，6 个月不良结局风险从 40.51% 增加到 96.43% ( p  < 0.001)。多变量分析表明，≥3/11 变量 (≥0.27) 的更高 mFI 评分表明 30 天死亡率 ( p  = 0.009) 和不利结果 ( p  < 0.001) 的风险显着更高。我们得出结论，在一级神经创伤中心就诊的 aSDH 老年患者中，通过 mFI 衡量的日益虚弱与 30 天死亡率和 6 个月不良结果的风险显着升高相关。对于这一快速增长的人群，评估老年 aSDH 患者的 mFI 可能是一个有用的决定因素。