Deepti K Tantry, Vikas N Vattipally, Jason Barber, Nancy R Temkin, Geoffrey T Manley, David O Okonkwo, Claudia S Robertson, Joseph T Giacino, Michael A McCrea, Lindsay D Nelson, Randall Chesnut, Shankar Gopinath, Ramesh Grandhi, C Dirk Keene, Vijay Krishnamoorthy, Christine Mac Donald, Randall Merchant, Pratik Mukherjee, Laura B Ngwenya, David Schnyer, Sabrina R Taylor, John K Yue, Ross Zafonte, John R Williams, Nicholas Theodore, Tej D Azad, Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) Investigators
Traumatic brain injury (TBI) is a significant public health concern, particularly in aging populations. While advanced age and frailty affect outcomes after TBI, the independent effect of frailty on long-term outcomes in geriatric TBI patients remains poorly understood. We hypothesized that higher disease-specific frailty is independently associated with poor long-term outcomes and quality of life following TBI. To determine whether a TBI-specific frailty index assessed at presentation is associated with long-term functional outcomes in older adults with TBI. We performed a secondary analysis of the TRACK-TBI cohort, restricting to patients ≥ 65 years. Frailty was quantified using a TRACK-TBI frailty index. Primary outcomes were 12-month Extended Glasgow Outcome Scale (GOSE), Quality of Life after Brain Injury (QoLIBRI), and Wechsler Adult Intelligence Scale Processing Speed Index (WAIS-PSI). Secondary outcomes included 6-month measures, inpatient mortality/discharge alive status, and discharge disposition. Associations were evaluated using adjusted regression models. The sample included 358 geriatric TBI patients (median age 72 years). Frail patients presented with worse admission assessments and higher incidence of TBI-related injuries. Higher frailty was independently associated with lower quality of life: adjusted mean 12-month QoLIBRI was 10.9 points lower in frail patients (95% CI 2.9-18.8; P = 0.007). High-frailty patients had lower odds of favorable 12-month GOSE (adjusted OR 0.54; 95% CI 0.29-1.03; P = 0.06). No adjusted differences were observed for WAIS-PSI. Among older adults with TBI, higher frailty at presentation was independently associated with worse quality of life. These findings suggest that frailty assessment may provide prognostic information for risk stratification and patient counseling in geriatric TBI, warranting further prospective evaluation.