The effectiveness of clinical frailty assessment in older patients with Traumatic brain injury in predicting outcome and quality of life: a systematic review

Ground-level falls are the most common cause of Traumatic brain injury (TBI) leading to emergency hospital admissions, in adults aged 65 years and older. The world’s population is ageing and frailty is becoming more relevant in healthcare provision, therefore assessment of frailty on admission is integral to care planning. Identifying whether frailty is a risk factor for poor outcomes may facilitate clinical decision making and direct care appropriately. This review aimed to evaluate the effectiveness of a clinical frailty assessment or scale in predicting outcomes in older patients following a TBI, including mortality, functional recovery, hospital length of stay, and discharge disposition. A systematic review of OVID, EBSCO, Elsevier and Wiley from 2005 to 2025. Included a majority of patients aged 65 years and over, diagnosed with a TBI with a validated frailty assessment tool and at least one outcome measure reported. A total of 12 observational studies (464,606 patients) were included, with a mean age ranging between 70 and 83 years. These studies utilised seven distinct frailty assessment tools. Falls from standing were the most common mechanism of injury identified. Frailty was associated with 30-day and 1-year mortality and unfavourable outcome in combination with a reduced Glasgow Coma Score (GCS) on admission. Frailty was an independent predictor of length of hospital stay, discharge disposition and functional recovery but no study used a validated quality of life tool. Various frailty assessment tools demonstrate effectiveness in predicting clinical outcomes when used in combination with patients age, co-morbidity and neurological evaluation. The predictive value of these tools supports their clinical utility in clinical decision making. Further prospective research is needed to understand how frailty relates to longer term outcomes, particularly quality of life, which was not measured in the included studies. Clinical trial number Not applicable.