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Early Predictors for Long-Term Functional Outcome After Mild Traumatic Brain Injury in Frail Elderly Patients

Abdulle, Amaal Eman, BSc; de Koning, Myrthe E., BSc; van der Horn, Harm J., MSc; Scheenen, Myrthe E., Msc; Roks, Gerwin, MD, PhD; Hageman, Gerard, MD, PhD; Spikman, Jacoba M., PhD; van der Naalt, Joukje, MD, PhD

The Journal of Head Trauma Rehabilitation: November/December 2018 - Volume 33 - Issue 6 - p E59–E67
doi: 10.1097/HTR.0000000000000368
Focus on Clinical Research and Practice

Objective: To identify the effect of frailty and early postinjury measures on the long-term outcome after mild traumatic brain injury in elderly patients.

Setting: Patients admitted to 3 Dutch hospitals designated as level 1 trauma centers.

Participants: The elderly (≥60 years) with mild traumatic brain injury (N = 161).

Design: A prospective observational cohort study.

Main Measures: Posttraumatic complaints and the Hospital Anxiety and Depression Scale determined 2 weeks postinjury; the Glasgow Outcome Scale Extended and Groningen frailty indicator determined 1 to 3 years postinjury.

Results: A total of 102 nonfrail (63%) and 59 frail elderly (37%) patients, mean age of 70.8 (6.3) years were included. Most patients (54%; 72% nonfrail and 24% frail) recovered completely 1 to 3 years postinjury. Two weeks postinjury, 81% had posttraumatic complaints (83% frail and 80% nonfrail elderly), and 30% showed emotional distress (50% frail and 20% nonfrail). Frailty (odds ratio, 2.1; 95% confidence interval, 1.59-2.77) and presence of early complaints (odds ratio, 1.13; 95% confidence interval, 1.01-1.27) (Nagelkerke R 2 = 46%) were found to predict long-term outcome, whereas age was not a significant predictor.

Conclusion: The frail elderly had worse long-term outcome, and early complaints were found to be a stronger predictor of unfavorable outcome than age. Understanding the implications of frailty on outcome could help clinicians recognize patients at risk of a poor outcome and allocate care more efficiently.

Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands (Mss Eman Abdulle and de Koning, Mr van der Horn, and Dr van der Naalt); Department of Clinical Neuropsychology, University of Groningen, the Netherlands (Mr Scheenen and Dr Spikman); Department of Neurology, Elisabeth Hospital, Tilburg, the Netherlands (Dr Roks); and Department of Neurology, Hospital Medisch Spectrum Twente, Enschede, the Netherlands (Dr Hageman).

Corresponding Author: Joukje van der Naalt, MD, PhD, Department of Neurology AB51, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands (

This study is supported by the Dutch Brain Foundation (grant Ps2012-06).

The authors declare no conflicts of interest.

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