Frailty Scores Predict Discharge Location Following Acute Subdural Hematoma. (16th November 2020) - Rawanduzy, Cameron
Abstract: INTRODUCTION: Frailty, i.e. a reduced physiologic reserve, has been associated with worse outcomes in neurosurgical patients. However, frailty's effect on acute subdural hemorrhage (aSDH) outcomes is unclear. METHODS: Patients who presented to the emergency department between January, 2016 and June, 2018 were retrospectively identified via ICD codes for aSDH. Patients' modified frailty index (mFI), Charlson comorbidity index (CCI), and temporalis muscle thickness (TMT) were calculated. Primary endpoints were death and discharge home. Multivariate logistic regressions were performed to evaluate predictors of primary endpoints. RESULTS: There were a total of 167 patients identified and 111 (66.5%) were male, the mean age was 63.4 ± 1.9 years, 30 (18.0%) patients underwent craniotomy, and 32 (19.2%) died during hospitalization. In multivariate analysis, decreasing iGCS (OR = 0.84; 95%CI:0.74-0.96; P = . 0112) and midline shift (MLS) (OR = 1.27; 95%CI: 1.08-1.50; P = . 0048), were the typical expected independent predictors of mortality, but not age or any frailty index. The higher iGCS (OR = 1.26; 95%CI:1.10-1.44) P = . 0011), lower CCI (OR = 0.32; 95%CI: 0.14-0.74; P = . 0071), and larger TMT (OR = 2.63; 95%CI: 1.16-5.99; P = . 0210) independently predicted increased rates of discharge to home. In a subgroup analysis of patients with non-severe MLS(<5mm) aSDH, iGCS was the only predictor of mortality (OR = 0.86; 95%CI: 0.75-0.99; P = . 0309), however, iGCS (OR = 1.34;95%CI:1.15-1.55; P < . 0001), lower CCI (OR = 0.37;95%CI:0.16-0.84; P = . 0307), and larger TMT (OR = 0.40;95%CI: 0.17-0.92; P = . 0307) independently predicted discharge to home. The mFI was not independently associated with either primary endpoint in multivariate analysis ( P > . 05). CONCLUSION: The effect of a patient's baseline frailty has not been explored in patients with aSDH. In line with prior literature, we show that iGCS predicts both mortality and discharge location following aSDH better than age or frailty. However, CCI and TMT, but not the mFI, are useful prognostic indicators of discharge to home among all patients and those with non-severe aSDH. The iGCS should continue to be the primary prediction tool for aSDH patients, however frailty, particularly with increased TMT & lower CCI, should be considered for long-term prognostication following aSDH.