scholarly journals Relevance of Presenting Risks of Frailty, Sarcopaenia and Osteopaenia to Outcomes From Aneurysmal Subarachnoid Haemorrhage

2021 ◽  
Author(s):  
Jia Xu Lim ◽  
Yuan Guang Lim ◽  
A Aravin Kumar ◽  
Tien Meng Cheong ◽  
Julian Xinguang Han ◽  
...  
Keyword(s):  
Brain Injury ◽  
Subarachnoid Haemorrhage ◽  
Frailty Index ◽  
Acute Brain Injury ◽  
World Federation ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Improvement Program ◽  
Modified Frailty Index ◽  
Neurological Surgery

Abstract IntroductionAneurysmal subarachnoid haemorrhage (aSAH) is a condition with significant morbidity and mortality. In the context of acute brain injury, frailty, sarcopaenia and osteopaenia have become increasing concerns. Multiple indices have been devised in various surgical specialties to predict outcome and guide management. In this study, we examined whether such markers have relevance towards outcomes from acute brain conditions, such as aSAH. MethodsAn observational study in a tertiary neurosurgical unit on 51 consecutive patients with ruptured aSAH was performed. We compared various frailty indices (modified frailty index 11, and 5, and the National Surgical Quality Improvement Program score [NSQIP]), temporalis (TMT) and zygoma thickness (markers of sarcopaenia and osteopaenia), against traditional markers (age, World Federation of Neurological Surgery and modified Fisher scale [MFS]) for aSAH outcomes. ResultsTMT was the best performing marker in our cohort with an AUC of 0.82, Somers’ D statistic of 0.63 and Tau statistic 0.25. Of the frailty scores, the NSQIP performed the best (AUC 0.69, Somer’s D 0.40, Tau 0.16), at levels comparable to traditional markers of aSAH, such as MFS (AUC 0.68, Somer’s D 0.43, Tau 0.17). After multivariate analysis, patients with TMT ≥5.5mm (defined as non-frail), were less likely to experience complications (OR 0.20 [0.06 – 0.069], p = 0.011), and had a larger proportion of favourable mRS on discharge (95.0% vs. 58.1%, p = 0.024) and at 3-months (95.0% vs. 64.5%, p = 0.048). However, the gap between unfavourable and favourable mRS was insignificant at the comparison of 1-year outcomes. ConclusionTMT, as a marker of sarcopaenia, correlated well with the presenting status, and outcomes of aSAH. Frailty, as defined by NSQIP, performed at levels equivalent to aSAH scores of clinical relevance, suggesting that, in patients presenting with acute brain injury, both non-neurological and neurological factors were complementary in the determination of eventual clinical outcomes. Further validation of these markers, in addition to exploration of other relevant frailty indices, may help to better prognosticate aSAH outcomes and allow for a precision medicine approach to decision making and optimization of best outcomes Trial registrationNot applicable

The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury

2020 ◽  
Vol 86 (11) ◽  
pp. 1596-1601
Author(s):  
Brett M. Tracy ◽  
Margo N. Carlin ◽  
James W. Tyson ◽  
Mara L. Schenker ◽  
Rondi B. Gelbard
Keyword(s):  
Traumatic Brain Injury ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Brain Injury ◽  
Frailty Index ◽  
Kidney Injury ◽  
Care Hospital ◽  
Improvement Program ◽  
Multivariable Logistic Regression ◽  
Modified Frailty Index

Background Frailty has been studied extensively in trauma, but there is minimal research detailing its impact on traumatic brain injury (TBI). We hypothesized that the 11-item modified frailty index (mFI-11) would predict complications and discharge outcomes in patients with TBI. Methods A retrospective review of our trauma quality improvement program (TQIP) registry was conducted for all patients with TBI. The mFI-11 score was calculated for each patient. Multivariable logistic regression was used to assess the relationship between mFI-11 and cardiovascular, infectious, pulmonary, renal, thromboembolic, and unplanned complications (ie, unplanned intensive care unit [ICU] admission, intubation, or return to the operating room). Results There were 2352 patients with TBI of whom 61.6% (n = 1450) were not frail, 19.3% (n = 454) were mildly frail, and 19.1% (n = 448) were moderately to severely frail. Higher frailty scores were associated with increasing age ( P < .0001) and decreasing injury severity score [ISS] ( P = 0.001). Higher frailty scores also correlated with increasing rates of a skilled nursing facility/long-term acute care hospital/rehabilitation discharge ( P = .0002). On multivariable logistic regression adjusting for age, Glasgow Coma Scale (GCS) score, ISS, mechanism, and sex, moderate to severe frailty increased the odds of acute kidney injury (odds ratio [OR] 2.06, 95% CI 1.07-3.99, P = .03) and any unplanned event (OR 1.6, 95% CI 1.1-2.3, P = .01). Conclusion Frailty measured by the mFI-11 is associated with greater rates of discharge to unfavorable locations and increased odds of acute kidney injury and unplanned events among patients with TBI. These findings suggest that frail patients with TBIs require greater vigilance to avoid such unanticipated outcomes.

scholarly journals Early brain injury and cognitive impairment after aneurysmal subarachnoid haemorrhage

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Matthew J. Rowland ◽  
Payashi Garry ◽  
Martyn Ezra ◽  
Rufus Corkill ◽  
Ian Baker ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Brain Injury ◽  
Subarachnoid Haemorrhage ◽  
Acute Phase ◽  
Early Brain Injury ◽  
World Federation ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Healthy Controls ◽  
Good Grade ◽  
The Impact

AbstractThe first 72 h following aneurysm rupture play a key role in determining clinical and cognitive outcomes after subarachnoid haemorrhage (SAH). Yet, very little is known about the impact of so called “early brain injury” on patents with clinically good grade SAH (as defined as World Federation of Neurosurgeons Grade 1 and 2). 27 patients with good grade SAH underwent MRI scanning were prospectively recruited at three time-points after SAH: within the first 72 h (acute phase), at 5–10 days and at 3 months. Patients underwent additional, comprehensive cognitive assessment 3 months post-SAH. 27 paired healthy controls were also recruited for comparison. In the first 72 h post-SAH, patients had significantly higher global and regional brain volume than controls. This change was accompanied by restricted water diffusion in patients. Persisting abnormalities in the volume of the posterior cerebellum at 3 months post-SAH were present to those patients with worse cognitive outcome. When using this residual abnormal brain area as a region of interest in the acute-phase scans, we could predict with an accuracy of 84% (sensitivity 82%, specificity 86%) which patients would develop cognitive impairment 3 months later, despite initially appearing clinically indistinguishable from those making full recovery. In an exploratory sample of good clinical grade SAH patients compared to healthy controls, we identified a region of the posterior cerebellum for which acute changes on MRI were associated with cognitive impairment. Whilst further investigation will be required to confirm causality, use of this finding as a risk stratification biomarker is promising.

The impact of hypopituitarism on function and performance in subjects with recent history of traumatic brain injury and aneurysmal subarachnoid haemorrhage

Brain Injury ◽  
2009 ◽  
Vol 23 (7-8) ◽  
pp. 639-648 ◽  
Author(s):  
Lakshmi Srinivasan ◽  
Brian Roberts ◽  
Tamara Bushnik ◽  
Jeffrey Englander ◽  
David A. Spain ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Subarachnoid Haemorrhage ◽  
Recent History ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
History Of ◽  
And Performance ◽  
The Impact

Adapting the 5-factor modified frailty index for prediction of postprocedural outcome in patients with unruptured aneurysms

2021 ◽  
pp. 1-8
Author(s):  
James Feghali ◽  
Abhishek Gami ◽  
Sarah Rapaport ◽  
Jaimin Patel ◽  
Adham M. Khalafallah ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Frailty Index ◽  
Multivariable Analysis ◽  
Unruptured Aneurysm ◽  
Improvement Program ◽  
Unruptured Aneurysms ◽  
Major Complications ◽  
C Statistic ◽  
Physical Status Classification ◽  
Modified Frailty Index

OBJECTIVE The 5-factor modified frailty index (mFI-5) is a practical tool that can be used to estimate frailty by measuring five accessible factors: functional status, history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. The authors aimed to validate the utility of mFI-5 for predicting endovascular and microsurgical treatment outcomes in patients with unruptured aneurysms. METHODS A prospectively maintained database of consecutive patients with unruptured aneurysm who were treated with clip placement or endovascular therapy was used. Because patient age is an important predictor of treatment outcomes in patients with unruptured aneurysm, mFI-5 was supplemented with age to create the age-supplemented mFI-5 (AmFI-5). Associations of scores on these indices with major complications (symptomatic ischemic or hemorrhagic stroke, pulmonary embolism, pneumonia, or surgical site infection requiring reoperation) were evaluated. Validation was carried out with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2006–2017). RESULTS The institutional database included 275 patients (88 underwent clip placement, and 187 underwent endovascular treatment). Multivariable analysis of the surgical cohort showed that major complication was significantly associated with mFI-5 (OR 2.0, p = 0.046) and AmFI-5 (OR 1.9, p = 0.028) scores. Significant predictive accuracy for major complications was provided by mFI-5 (c-statistic = 0.709, p = 0.011) and AmFI-5 (c-statistic = 0.720, p = 0.008). The American Society of Anesthesiologists Physical Status Classification System (ASA) provided poor discrimination (area under the curve = 0.541, p = 0.618) that was significantly less than that of mFI-5 (p = 0.023) and AmFI-5 (p = 0.014). Optimal relative fit was achieved with AmFI-5, which had the lowest Akaike information criterion value. Similar results were obtained after equivalent analysis of the endovascular cohort, with additional significant associations between index scores and length of stay (β = 0.6 and p = 0.009 for mFI-5; β = 0.5 and p = 0.003 for AmFI-5). In 1047 patients who underwent clip placement and were included in the NSQIP database, mFI-5 (p = 0.001) and AmFI-5 (p < 0.001) scores were significantly associated with severe postoperative adverse events and provided greater discrimination (c-statistic = 0.600 and p < 0.001 for mFI-5; c-statistic = 0.610 and p < 0.001 for AmFI-5) than ASA score (c-statistic = 0.580 and p = 0.003). CONCLUSIONS mFI-5 and AmFI-5 represent potential predictors of procedure-related complications in unruptured aneurysm patients. After further validation, integration of these tools into clinical workflows may optimize patients for intervention.

scholarly journals Outcome and rehabilitation of patients following aneurysmal subarachnoid haemorrhage

2017 ◽  
Vol 04 (04) ◽  
pp. S65-S75 ◽  
Author(s):  
Dhaval Shukla
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Subarachnoid Haemorrhage ◽  
Functional Outcome ◽  
Outcome Measures ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Clinical Grade ◽  
The Past ◽  
Main Determinants ◽  
Neuropsychological Impairments

AbstractAneurysmal subarachnoid haemorrhage (SAH) is a dreaded neurosurgical disorder. Although the mortality has been declining in the past three decades, the disability after SAH is still significant. The main determinants of outcome are age, clinical grade, amount of SAH and size of aneurysm. Both neurophysical deficits and neuropsychological impairments are determinants of functional outcome after SAH. Patients should be assessed using outcome measures for both traumatic brain injury and stroke. Early rehabilitation after SAH improves not only physical outcome but also cognitive and functional outcome.

scholarly journals Management of aneurysmal subarachnoid haemorrhage with intracerebral hematoma: Is there an indication for coiling first? Study of 44 cases

2015 ◽  
Vol 22 (1) ◽  
pp. 5-11
Author(s):  
Céline Salaud ◽  
Olivier Hamel ◽  
Tanguy Riem ◽  
Hubert Desal ◽  
Kevin Buffenoir
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Poor Prognosis ◽  
Intracerebral Hematoma ◽  
World Federation ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Aneurysm Clipping ◽  
Good Outcome ◽  
A Prospective Study ◽  
Aneurysm Coiling ◽  
Radiologic Characteristics

Background Aneurysmal subarachnoid haemorrhage (ASH) with intracerebral hematoma (ICH) has a poor prognosis. The treatment is to secure the aneurysm and do an ICH evacuation. Objective The aim of the study was to determine if aneurysm coiling followed by ICH evacuation is a viable alternative treatment compared to exclusive surgery, regardless of the clinical or paraclinical presentations. Methods A retrospective study was conducted between 2004 and 2014, which included 44 patients. The patients were divided up in four groups. Two were principal groups: The clipped group (aneurysm clipping with ICH evacuation) and the coiled group (aneurysm coiling, followed by ICH evacuation); and two were subgroups of the latter: Aneurysm coiling with ICH evacuation after 24 hours and ICH evacuation followed by aneurysm coiling. We studied the demographic and radiologic characteristics, and the 3-month outcome. Results We included 17 patients in the coiled group: The outcome was better for the patients with World Federation of Neurosurgery (WFNS) scores of 1, 2 and 3; compared to the patients with WFNS scores 4 and 5. We included 16 patients in the clipped group: The outcome was better, compared the coiled group, for those patients with WFNS scores 4 and 5. Six patients were treated with aneurysm coiling, followed by ICH evacuation after 24 hours: 33% had a good outcome. Five patients were treated by ICH evacuation, followed by aneurysm coiling: None had a good outcome. Conclusions It was necessary to realise a prospective study to compare the outcomes of patients with WFNS scores of 1, 2 or 3; between those with aneurysm coiling followed by ICH evacuation and aneurysm clipping with ICH evacuation, to determine the potential of using the coiling first, for these patients.

scholarly journals The Impact of Frailty on Morbidity and Mortality following Open Emergent Colectomies

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Dominick V. Congiusta ◽  
Prashanth Palvannan ◽  
Aziz M. Merchant
Keyword(s):  
Care Setting ◽  
Frailty Index ◽  
Acute Care Setting ◽  
Improvement Program ◽  
Mortality And Morbidity ◽  
National Quality ◽  
American College Of Surgeons ◽  
Modified Frailty Index ◽  
The Impact ◽  
The Relationship

Background. Elderly and frail patients undergo open emergency colectomies and are at greater risk for complications. The relationship between frailty and open emergent colectomies is yet unexplored.Objective. The purpose of this study was to evaluate the relationship between frailty and outcomes after open emergent colorectal surgery.Design. Using the American College of Surgeons National Quality Improvement Program database, a validated modified frailty index was used, along with logistic regression, to assess the relationship between frailty and outcomes.Main Outcome Measures. Outcomes included mortality (primary), Clavien-Dindo Complication Grade >3, reintubation, ventilator >48 hours, and reoperation (secondary).Results. The rates for 30-day mortality, Clavien-Dindo Grade >3, reintubation, ventilator > 48 hours, and reoperation in our cohort were 16.6%, 36.9%, 8.6%, 23.9%, and 15.0%, respectively. There was a statistically significant increase in prevalence of all outcomes with increasing frailty.Limitations. A causal relationship between frailty and complications cannot be established in a retrospective analysis. Also, extrapolation of our data to reflect outcomes beyond 30 days must be done with caution.Conclusions. Frailty is a statistically significant predictor of mortality and morbidity after open emergent colectomies and can be used in an acute care setting.

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