An attempt to create prediction scores for elderly patients with mild head injury

Abstract

Purpose: Traumatic brain injury (TBI) is one of a leading cause of death and disability worldwide. It has been known that the survival and functional outcomes are significantly poor in the elderly population. Several criteria have been described to predict the mortality of patients with severe head injury, but only few have been studied on mild injury. We encounter high–functioning elderly patients with mild head injuries, whose functional outcomes gradually worsen over time during hospitalization. There is a need to develop a geriatric specific prognostic models of mild head injury for better treatment, rehabilitation and prevention. We aim to develop a simple scoring system to predict the functional outcomes of elderly with mild head injury.

Subjects and Methods: Retrospective study of patients 65 years or older with mild head injury for 2 consecutive years from September 2019 to September 2021. We evaluated age, sex, past histories (DM, HLP, heart diseases and CKD), GCS on admission, CT findings (contusion, SAH, ASDH and AEDH) and use of antithrombotic drugs. We generated a novel score to predict the functional outcomes of these patients using the beta coefficient. The score was validated in an internal Cohort.

Results: There were 72 patients in the development cohort and 21 patients in the validation cohort. GCS, ASDH, contusion and DM were identified as predictors of functional outcomes and were in­cluded for generating the GACD score. A patient with GACD score > 3 may have high risk of talk–and–deteriorate during hospitaliza­tion. The positive and negative predictive value for our score was 67% and 87%, respectively.

Conclusion: We propose a new and easy–to–use scoring system to predict the functional outcomes of elderly with mild head injury.