Assessment of the incremental prognostic value from the modified frailty index-5 in complete traumatic cervical spinal cord injury.

Frailty, as measured by the modified frailty index-5 (mFI-5), and older age are associated with increased mortality in the setting of spinal cord injury (SCI). However, there is limited evidence demonstrating an incremental prognostic value derived from patient mFI-5. We conducted a retrospective cohort study to evaluate in-hospital mortality among adult complete cervical SCI patients at participating centers of the Trauma Quality Improvement Program from 2010 to 2018. Logistic regression was used to model in-hospital mortality, and the area under the receiver operating characteristic curve (AUROC) of regression models with age, mFI-5, or age with mFI-5 was used to compare the prognostic value of each model. 4733 patients were eligible. We found that both age (80 y versus 60 y: OR 3.59 95% CI [2.82 4.56], P < 0.001) and mFI-5 (score ≥ 2 versus < 2: OR 1.53 95% CI [1.19 1.97], P < 0.001) had statistically significant associations with in-hospital mortality. There was no significant difference in the AUROC of a model including age and mFI-5 when compared to a model including age without mFI-5 (95% CI Δ AUROC [- 8.72 × 10-4 0.82], P = 0.199). Both models were superior to a model including mFI-5 without age (95% CI Δ AUROC [0.06 0.09], P < 0.001). Our findings suggest that mFI-5 provides minimal incremental prognostic value over age with respect to in-hospital mortality for patients complete cervical SCI.

Effect of demographic and injury etiologic factors on intensive care unit mortality after severe head injury in a low middle income country.

BACKGROUND: Low- and middle-income countries bear the mortality burden of head injury compared with high-income countries. Not much has been studied about predictors of poor outcome after head injury in these countries. This study describes and quantifies the effect of demographics and injury causative factors on mortality in a cohort managed in a Nigerian tertiary hospital intensive care. MATERIALS AND METHODS: A retrospective study was undertaken of all patients admitted into intensive care with severe head injury at the University of Port Harcourt Teaching Hospital, Nigeria between 1 st January, 1997 and 31 st December, 2006. Logistic regression analysis was performed to examine the effect of age, gender and injury etiology on risk of intensive care unit (ICU) mortality. RESULTS: The number of ICU admission for severe head injury was 231 patients with a male to female ratio of 2.8:1. Patients' mean age and standard deviation was 31.2 ± 15.5 years. The mortality rate was 52.8%. Road traffic injury was the most common etiologic factor (84%). Logistic regression analysis indicated a 56% increase in the risk of ICU mortality between the ages of 21 and 40 years. The effect of age was found to be nonlinear (likelihood ratio P = 0.033). On multivariable analysis, patient's gender (odds ratio 1.07; 95% confidence interval: 0.56-1.97) and etiology of injury were not significantly associated with risk of mortality. Gender was not a modifier of the effect of age (P = 0.218). CONCLUSION: The study indicated a strong prognostic effect of age. Gender and etiology of injury had no effect on ICU mortality among study cohort.