{
  "abstract": "Introduction Blunt cerebrovascular injury (BCVI) is a traumatic complication associated with ischemic stroke and increased mortality, with elderly patients representing a particularly high-risk subgroup. This study aimed to identify predictors of functional outcomes at 90 days and time to mortality in patients aged ≥65 years with BCVI, incorporating multiple frailty and comorbidity indices.Methods This retrospective single-center study included patients ≥65 years with BCVI (2015–2025). Demographic, clinical, and injury variables were collected. Frailty (mFI-5, RAI-rev) and comorbidity (CCI) indices were retrospectively calculated. Outcomes included 90-day functional independence and time to mortality. Predictors were assessed using multivariable logistic and Cox regression and random forest models, with performance compared using AUC and C-index.Results A total of 139 patients (median age 74.5 years) were included. Patients with functional dependence at 90 days had higher comorbidity and frailty burdens (CCI, mFI-5, RAI-rev; all P≤.002) and greater injury severity. Greater comorbidity and frailty were independently associated with lower odds of functional independence, whereas age was not. Frailty demonstrated the best discrimination for functional outcome, with mFI-5 achieving the highest performance (AUC 0.92), followed by RAI-rev (AUC 0.89), with consistent ranking in random forest variable importance. Additional predictors of functional independence included smoking, diabetes, ground-level falls, admission GCS, and ISS. For time to mortality, age, CCI, and RAI-rev were independent predictors, with RAI-rev achieving the highest discrimination (C-index 0.81). Antithrombotic treatment strategy and in-hospital stroke were additional independent predictors of time to mortality. Frail patients (RAI-rev ≥31) had worse functional outcomes, higher mortality, and increased healthcare utilization.Conclusions In elderly patients with BCVI, frailty outperformed age and comorbidity in predicting functional outcomes and mortality. RAI-rev showed consistent discrimination, with a threshold of 31 stratifying risk. As outcomes are largely driven by baseline vulnerability and injury characteristics, efforts should prioritize primary prevention, particularly fall prevention in frail elderly individuals.Disclosures O. Shoraka: None. D. Botros: None. L. Hale: None. A. Acharya: None. S. Clark: None.Abstract P-017 Table 1",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "O Shoraka"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "D Botros"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "L Hale"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "A Acharya"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "S Clark"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "R Grandhi"
    }
  ],
  "title": "P-017 Determinants of outcome in elderly blunt cerebrovascular injury: which measures best predict prognosis?",
  "uid": "b0af6468-9d56-5d2e-a283-292aab4a31da"
}