Journal of Indira Gandhi Institute Of Medical Sciences · Jul 2026
Frailty indices as predictors of mortality in chronic subdural hematoma: A longitudinal study
By Rajendran NH, Singh SK, Chandrasekaran S
Background: Chronic subdural hematoma (cSDH) is increasingly encountered in neurosurgical practice, particularly among older adults with multiple comorbid conditions. Frailty has gained attention as a potential determinant of outcomes in these patients; however, evidence comparing commonly used frailty measures with traditional neurological assessment tools remains limited. This study examined the relationship between frailty indices and 6-month mortality in patients undergoing treatment for cSDH. Methodology: In this retrospective longitudinal study, medical records of 65 adults with radiologically confirmed cSDH managed at a tertiary care center were reviewed. Frailty status was evaluated using the Charlson Comorbidity Index (CCI), Modified Frailty Index-11 (mFI-11), and mFI-5. Mortality within 6 months of diagnosis served as the primary outcome. Associations were explored using bivariate analysis, multivariable logistic regression, and Cox proportional hazards modeling. Results: Twelve patients (18.5%) died during the 6-month follow-up period. After adjustment for covariates, patients classified as frail by CCI (adjusted odds ratio [AOR]: 4.85; 95% confidence interval [CI]: 1.10-21.52; P = 0.037) and mFI-11 (AOR: 7.92; 95% CI: 1.55-40.41; P = 0.013) demonstrated significantly greater odds of mortality. Similar findings were observed in survival analyses, with CCI (hazard ratio [HR]: 2.75; 95% CI: 1.12-6.77; P = 0.027) and mFI-11 (HR: 3.94; 95% CI: 1.42-10.93; P = 0.008) remaining significant predictors. No significant association was identified for mFI-5. Higher Glasgow Coma Scale at admission was associated with lower mortality risk (HR: 0.78 per point increase; P = 0.022). Conclusions: Patients classified as frail according to CCI and mFI-11 had a significantly higher risk of mortality following cSDH. Incorporating frailty assessment into routine evaluation may complement neurological assessment and improve prognostic risk stratification.