Clinical Frailty Scale Combined With CT Score Can Evaluate Early Prognosis Of Elderly Patients With Traumatic Brain Injury

Objective:The number of patients with traumatic brain injury(TBI)in China is increasing year by year.With the development of population aging,the proportion of elderly patients in adult TBI patients is also gradually increasing.Most of the current studies on the prognosis of elderly TBI patients are extracted from the data of adult populations(age≥18 years),and there are few studies on elderly TBI patients alone.The aim of this study was to investigate the role of clinical frailty scale combined with CT score in the assessment of early prognosis in elderly patients with TBI.Methods:A total of 160 elderly patients with TBI admitted to the Emergency Department of the First Hospital of Shanxi Medical University from September 2021 to August 2022 were collected.According to the 60-day prognosis,the patients were divided into good prognosis group(GOS4-5)and poor prognosis group(GOS 1-3).The general data of the patients and the results of the first head CT were collected.The general data included age,gender,injury mechanism,combined with other injuries,head AIS,ISS,anticoagulant and/or antiplatelet aggregation drugs,GCS on admission,pupil reflex,Charlson Comorbidity Index(CCI),and Clinical Frailty Scale(CFS).Rotterdam CT score and Helsinki CT score were calculated according to the CT results.The above indicators were analyzed by univariate analysis,and the indicators with statistically significant differences(P < 0.05)in univariate analysis were included in multivariate logistic regression.Taking poor prognosis as the dependent variable,the indicators affecting the early poor prognosis of elderly patients with TBI were further analyzed.Finally,the receiver operating characteristic curve(ROC curve)was drawn to evaluate the predictive value of each index and combined index for poor prognosis.Results:Compared with the good prognosis group,the age,head AIS,ISS,CCI,Rotterdam CT score,Helsinki CT score were higher,and GCS score was lower in the poor prognosis group.Fall,frailty(CFS≥5)and absent pupillary reflex were more common in the poor prognosis,and the differences were statistically significant(P < 0.05).Multivariate logistic regression analysis showed that frailty(CFS≥5)(OR=28.463,95%CI6.854-118.196,P<0.001),Helsinki CT(OR=1.675,95%CI 1.291-2.173,P<0.001)and GCS(OR=0.830,95%CI 0.730-0.944,P=0.004)significantly affected the prognosis of patients.The ROC curve showed that the area under the curve(AUC)of Helsinki CT curve(0.837)was the largest among the single indicators.Among the pairwise combined indicators,the combined indicator of Helsinki CT and frailty(CFS≥5)had the largest AUC(0.905),and the combined indicator of GCS,frailty(CFS≥5)and Helsinki CT had the largest AUC(0.918).Conclusion:Frailty(CFS≥5),Helsinki CT and GCS are significantly correlated with the early prognosis of elderly patients with TBI.Single or combined indicators can predict poor prognosis in elderly patients with TBI.Helsinki CT has a better predictive efficiency in single index.The combined index of Helsinki CT and frailty(CFS≥5)had the best predictive efficiency among any two combined indicators.The combination of frailty(CFS≥5),Helsinki CT and GCS had the best predictive efficacy compared with other indicators.