Frailty Evaluation for Short-Term Mortality Prediction of Patients With Traumatic Brain Injury: A Meta-Analysis

Frailty is increasingly recognized as an important prognostic factor in trauma patients. Its role in predicting short-term mortality after traumatic brain injury (TBI), however, remains uncertain. A systematic review and meta-analysis were conducted to evaluate the association between baseline frailty and short-term mortality (within 12 months) in TBI patients.

Cohort studies were identified through PubMed, Embase, and Web of Science up to March 2025. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Fifteen datasets from 14 cohort studies, comprising 1 567 950 patients, were included. Frailty was significantly associated with increased short-term mortality (OR, 1.58; 95% CI, 1.30-1.93; P < .001; I2  = 93%). Sensitivity analyses showed consistent findings (OR range: 1.48-1.66). Subgroup analyses revealed stronger associations in prospective versus retrospective studies (OR, 3.27 vs 1.41; P < .001), and in studies involving general TBI populations compared to those focusing on subdural hematoma or intracranial hemorrhage (OR, 2.03 vs 1.19; P < .001). The association remained consistent across age groups and sex distribution. Although numerically stronger in studies using non-modified frailty index (OR 2.00 vs 1.31), the difference was not statistically significant ( P = .05). The association was most pronounced at 6-month follow-up compared to 1 month or during hospitalization and was attenuated in studies using multivariate rather than univariate analyses ( P < .001).

Frailty may be independently associated with short-term mortality in patients with TBI. Incorporating frailty assessment may enhance risk stratification and support clinical decision-making.