Impact of Frailty Risk on Adverse Outcomes after Traumatic Brain Injury: A Historical Cohort Study

We evaluated the utility of the Hospital Frailty Risk Score (HFRS) as a predictor of adverse events after hospitalization in a retrospective analysis of traumatic brain injury (TBI). This historical cohort study analyzed the data of patients hospitalized with TBI between April 2014 and August 2020 who were registered in the JMDC database. We used HFRS to classify the patients into the low- (HFRS < 5), intermediate- (HFRS5-15), and high- (HFRS > 15)-frailty risk groups. Outcomes were the length of hospital stay, the number of patients with Barthel Index score >= 95 on, Barthel Index gain, and in-hospital death. We used logistic and linear regression analyses to estimate the association between HFRS and outcome in TBI. We included 18,065 patients with TBI (mean age: 71.8 years). Among these patients, 10,139 (56.1%) were in the low-frailty risk group, 7388 (40.9%) were in the intermediate-frailty risk group, and 538 (3.0%) were in the high-frailty risk group. The intermediate- and high-frailty risk groups were characterized by longer hospital stays than the low-frailty risk group (intermediate-frailty risk group: coefficient 1.952, 95%; confidence interval (CI): 1.117-2.786; high-frailty risk group: coefficient 5.770; 95% CI: 3.160-8.379). The intermediate- and high-frailty risk groups were negatively associated with a Barthel Index score >= 95 on discharge (intermediate-frailty risk group: odds ratio 0.645; 95% CI: 0.595-0.699; high-frailty risk group: odds ratio 0.221; 95% CI: 0.157-0.311) and Barthel Index gain (intermediate-frailty risk group: coefficient -4.868, 95% CI: -5.599--3.773; high-frailty risk group: coefficient -19.596, 95% CI: -22.242--16.714). The intermediate- and high-frailty risk groups were not associated with in-hospital deaths (intermediate-frailty risk group: odds ratio 0.901; 95% CI: 0.766-1.061; high-frailty risk group: odds ratio 0.707; 95% CI: 0.459-1.091). We found that HFRS could predict adverse outcomes during hospitalization in TBI patients.