Frailty and In-Hospital Mortality Following Complete Cervical Spinal Cord Injury
Bibliographic record
Abstract
Study Design: Retrospective multicenter cohort study. Objective: To evaluate the independent association between frailty and in-hospital mortality among adults with complete cervical spinal cord injury (SCI) who underwent surgical intervention. Summary of Background Data: Traumatic cervical SCI is a devastating condition associated with high rates of morbidity and early mortality. While advanced age and injury severity are established risk factors, frailty has emerged as a promising marker of physiological vulnerability. However, its prognostic value in complete cervical SCI remains unclear. Materials and Methods: Data were obtained from the American College of Surgeons Trauma Quality Improvement Program (TQIP) between 2017 and 2022. Adults (≥18 y) with blunt traumatic complete cervical SCI who underwent spinal surgery were included. Frailty was measured using the modified Frailty Index (mFI-5) and categorized as robust (0), prefrail (1), or frail (≥2). The primary outcome was all-cause in-hospital mortality, analyzed using Kaplan-Meier and Cox proportional hazards models, adjusting for demographic, clinical, injury-related, and hospital-level variables. A subgroup analysis was performed in patients aged 65 years or older. A predictive model for in-hospital mortality was developed using LASSO logistic regression. Results: Among 9457 patients, 70% were robust, 18% prefrail, and 12% frail. In-hospital mortality rates were 6% (robust), 15% (prefrail), and 23% (frail). Kaplan-Meier curves showed stepwise decreases in survival with increasing frailty (log-rank P <0.001). In adjusted Cox models, frailty was independently associated with mortality (HR: 1.45; 95% CI: 1.19–1.77; P <0.001), an association that persisted in patients aged 65 years or older (HR: 1.58; 95% CI: 1.11–2.26). The LASSO prediction model demonstrated good discrimination (AUC=0.811), with frailty among the top predictors of mortality. Conclusions: Frailty is an independent predictor of in-hospital mortality in adults undergoing surgery for complete cervical SCI. These findings support routine frailty assessment to enhance early risk stratification, prognostication, and patient-centered decision-making in spinal trauma care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".