Association between the Osteoporosis Self-Assessment Tool for Asians Score and Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury: A Propensity Score-Matched Analysis

Abstract

Background: The purpose of this study was to use a propensity score-matched analysis to investigate the association between the Osteoporosis Self-Assessment Tool for Asians (OSTA) scores and clinical outcomes of patients with isolated moderate and severe traumatic brain injury (TBI). Methods: The study population comprised 7855 patients aged ≥40 years who were hospitalized for treatment of isolated moderate and severe TBI (an Abbreviated Injury Scale (AIS) ≥3 points only in the head and not in other regions of the body) between 1 January 2009 and 31 December 2014. Patients were categorized as high-risk (OSTA score < −4; n = 849), medium-risk (−4 ≤ OSTA score ≤ −1; n = 1647), or low-risk (OSTA score > −1; n = 5359). Two-sided Pearson’s chi-squared, or Fisher’s exact tests were used to compare categorical data. Unpaired Student’s t-test and Mann-Whitney U test were performed to analyze normally and non-normally distributed continuous data, respectively. Propensity score-matching in a 1:1 ratio was performed using NCSS software, with adjustment for covariates. Results: Compared to low-risk patients, high- and medium-risk patients were significantly older and injured more severely. The high- and medium-risk patients had significantly higher mortality rates, longer hospital length of stay, and a higher proportion of admission to the intensive care unit than low-risk patients. Analysis of propensity score-matched patients with adjusted covariates, including gender, co-morbidity, blood alcohol concentration level, Glasgow Coma Scale score, and Injury Severity Score revealed that high- and medium-risk patients still had a 2.4-fold (odds ratio (OR), 2.4; 95% confidence interval (CI), 1.39–4.15; p = 0.001) and 1.8-fold (OR, 1.8; 95% CI, 1.19–2.86; p = 0.005) higher mortality, respectively, than low-risk patients. However, further addition of age as a covariate for the propensity score-matching demonstrated that there was no significant difference between high-risk and low-risk patients or between medium-risk and low-risk patients, implying that older age may contribute to the significantly higher mortality associated with a lower OSTA score. Conclusions: Older age may be able to explain the association of lower OSTA score and higher mortality rates in patients with isolated moderate and severe TBI.

Mortality prediction in patients with isolated moderate and severe traumatic brain injury using machine learning models

“…Detailed patient information between January 2009 and December 2015 was retrieved from the Trauma Registry System of the hospital. The adult patient cohort included those who were ≥ 20 years of age and hospitalized for the treatment of moderate and severe TBI, defined as an AIS score ≥ 3 points in the head (moderate TBI, AIS 3–4; severe TBI, AIS 5) [ 13 , 14 ]. Polytrauma patients who had additional AIS scores ≥ 3 points corresponding to any other region of the body were excluded from this study [ 14 ].…”

“…The adult patient cohort included those who were ≥ 20 years of age and hospitalized for the treatment of moderate and severe TBI, defined as an AIS score ≥ 3 points in the head (moderate TBI, AIS 3–4; severe TBI, AIS 5) [ 13 , 14 ]. Polytrauma patients who had additional AIS scores ≥ 3 points corresponding to any other region of the body were excluded from this study [ 14 ]. Enrolled patients were divided into a training set (a 6-year span between 2009 and 2014) for generation of a plausible model under supervised classification, and a test set (a 1-year span in 2015) to test the performance of the model.…”

Bone marrow derived extracellular vesicles activate osteoclast differentiation in traumatic brain injury induced bone loss

“…Clinical data suggest a strong correlation between TBI and dysfunctions in autonomic regulation, neuroendocrine function, and psychiatric stability [1,[5][6][7][8]. Moreover, recent studies suggest that increased fracture rate is another long-term consequence of TBI [13][14][15][16][17][18][19][20][21]. The combination of an increased fall risk and low bone mineral density post-TBI has been associated with increased fracture rates [1,[8][9][10][11][12][13][14][15][16][17][18][19][20][21]7].…”

“…In addition to the neurological consequences, TBI induces systemic immune changes that affect peripheral organs and worsen long-term quality of life [7][8][9][10][11][12]. Along these lines, TBI increases the risk of falls, fractures, osteopenia, and osteoporosis [13][14][15][16][17][18][19][20][21]. The increased risk for osteopenia and osteoporosis directly correlates with an elevated incidence of fractures and associated morbidity and mortality [22][23][24].…”

Epidemiology of Bone Fracture in Female Trauma Patients Based on Risks of Osteoporosis Assessed using the Osteoporosis Self-Assessment Tool for Asians Score

“…In addition, at the cutoff of −1, the difference in OSTA performance was minimal regardless of using the femoral neck and lumbar spine BMD as reference [ 20 ]. Based on the OSTA scores, patients could be stratified as with low (OSTA > −1), medium (−1 ≥ OSTA ≥ −4), and high risk (OSTA < −4) for sustaining osteoporosis [ 21 , 22 ]. It is estimated that the probability of a patient with an OSTA score >−4 not having osteoporosis is 99.3% [ 23 ].…”