ASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injury
Abstract Purpose This study aimed to investigate whether incorporating pre-injury health status, measured by the American Society of Anesthesiologists (ASA) score, improves outcome prediction models for moderate-to-severe traumatic brain injury (msTBI) patients. Methods We conducted a retrospective...
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BMC
2025-02-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s13049-025-01338-x |
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| author | Olivia Kiwanuka Philipp Lassarén Alexander Fletcher-Sandersjöö Charles Tatter Jonathan Tjerkaski David W. Nelson Eric P. Thelin |
| author_facet | Olivia Kiwanuka Philipp Lassarén Alexander Fletcher-Sandersjöö Charles Tatter Jonathan Tjerkaski David W. Nelson Eric P. Thelin |
| author_sort | Olivia Kiwanuka |
| collection | DOAJ |
| description | Abstract Purpose This study aimed to investigate whether incorporating pre-injury health status, measured by the American Society of Anesthesiologists (ASA) score, improves outcome prediction models for moderate-to-severe traumatic brain injury (msTBI) patients. Methods We conducted a retrospective single-center study of msTBI patients (2005–2021). The primary outcome was 1-year Glasgow Outcome Scale (GOS, dichotomized as GOS1-3 (unfavorable) vs. 4–5 (favorable)), and secondary outcome was 90-day mortality. Logistic regression evaluated the contribution of ASA score to the International Mission for Prognosis and Clinical Trials in Traumatic Brain Injury (IMPACT) core + CT outcome prediction model incorporating age, admission GCS, pupillary reactivity, Marshall CT classification, hypoxia, hypotension, epidural hematoma, and subarachnoid hemorrhage. Results Among the 720 adult patients that were included 51% had an unfavorable GOS at 1 year. The 90-day mortality was 19%. ASA score and TRISS were independently associated with both outcomes (p < 0.001). Incorporating the ASA score to our IMPACT model significantly enhanced its explanatory value of dichotomized GOS (35% vs. 32% variance explained, p < 0.001) and improved the model’s prognostic accuracy. Conclusion In this retrospective single-center cohort study, we found that ASA score improves existing prognostic models for msTBI. Incorporating this simple comorbidity measure could enhance outcome prediction and support more personalized acute management. Future prospective studies are needed to validate these results. |
| format | Article |
| id | doaj-art-76a93ce450bd4cbebefb9f5939705f55 |
| institution | Kabale University |
| issn | 1757-7241 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj-art-76a93ce450bd4cbebefb9f5939705f552025-02-09T12:52:14ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412025-02-0133111210.1186/s13049-025-01338-xASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injuryOlivia Kiwanuka0Philipp Lassarén1Alexander Fletcher-Sandersjöö2Charles Tatter3Jonathan Tjerkaski4David W. Nelson5Eric P. Thelin6Department of Clinical Neuroscience, Karolinska InstitutetDepartment of Clinical Neuroscience, Karolinska InstitutetDepartment of Clinical Neuroscience, Karolinska InstitutetDepartment of Clinical Neuroscience, Karolinska InstitutetDepartment of Clinical Sciences, Danderyd’s Hospital, Karolinska InstitutetSection of Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska InstitutetDepartment of Clinical Neuroscience, Karolinska InstitutetAbstract Purpose This study aimed to investigate whether incorporating pre-injury health status, measured by the American Society of Anesthesiologists (ASA) score, improves outcome prediction models for moderate-to-severe traumatic brain injury (msTBI) patients. Methods We conducted a retrospective single-center study of msTBI patients (2005–2021). The primary outcome was 1-year Glasgow Outcome Scale (GOS, dichotomized as GOS1-3 (unfavorable) vs. 4–5 (favorable)), and secondary outcome was 90-day mortality. Logistic regression evaluated the contribution of ASA score to the International Mission for Prognosis and Clinical Trials in Traumatic Brain Injury (IMPACT) core + CT outcome prediction model incorporating age, admission GCS, pupillary reactivity, Marshall CT classification, hypoxia, hypotension, epidural hematoma, and subarachnoid hemorrhage. Results Among the 720 adult patients that were included 51% had an unfavorable GOS at 1 year. The 90-day mortality was 19%. ASA score and TRISS were independently associated with both outcomes (p < 0.001). Incorporating the ASA score to our IMPACT model significantly enhanced its explanatory value of dichotomized GOS (35% vs. 32% variance explained, p < 0.001) and improved the model’s prognostic accuracy. Conclusion In this retrospective single-center cohort study, we found that ASA score improves existing prognostic models for msTBI. Incorporating this simple comorbidity measure could enhance outcome prediction and support more personalized acute management. Future prospective studies are needed to validate these results.https://doi.org/10.1186/s13049-025-01338-xModerate/severe TBIASA scoreIMPACT1-year outcome90-day mortality |
| spellingShingle | Olivia Kiwanuka Philipp Lassarén Alexander Fletcher-Sandersjöö Charles Tatter Jonathan Tjerkaski David W. Nelson Eric P. Thelin ASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injury Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Moderate/severe TBI ASA score IMPACT 1-year outcome 90-day mortality |
| title | ASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injury |
| title_full | ASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injury |
| title_fullStr | ASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injury |
| title_full_unstemmed | ASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injury |
| title_short | ASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injury |
| title_sort | asa score is an independent predictor of 1 year outcome after moderate to severe traumatic brain injury |
| topic | Moderate/severe TBI ASA score IMPACT 1-year outcome 90-day mortality |
| url | https://doi.org/10.1186/s13049-025-01338-x |
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