{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:09:11Z","timestamp":1784117351895,"version":"3.55.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Outcome assessment after mild traumatic brain injury (mTBI) has largely focused on acute injury severity, while the role of pre-injury health has received comparatively less attention. The American Society of Anesthesiologists (ASA) physical status classification provides a simple measure of pre-existing health and comorbidity that may be relevant to early outcomes after trauma. This study examined whether pre-injury ASA class is independently associated with short-term mortality after mTBI and compared these associations with those observed in trauma patients without brain injury (NTBI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a nationwide retrospective study using the Swedish Trauma Registry (2018\u20132023). Adults (\u2265\u200918 years) with Glasgow Coma Scale (GCS)\u2009&gt;\u200912 were included and classified as mTBI (ICD-10 S06.0\u2013S06.9) or NTBI (no S06 diagnosis, AIS head\u2009=\u20090, age-matched). The primary outcome was 30-day all-cause mortality. Associations between clinical variables and mortality were examined using univariable and multivariable logistic regression, with models specified a priori to separate age\u2013ASA effects from injury-related adjustment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 8,670 patients were included in the mTBI cohort and 26,001 in the age-matched cohort. The mTBI cohort had poorer health (ASA\u2009\u2265\u20093: 27% vs 24%), and more often injured by low-energy falls (28% vs 20%). Mortality was higher in mTBI (5% vs 2.8%), and outcomes poorer (Glasgow Outcome Scale 1\u20133: 23% vs 17%).<\/jats:p>\n                    <jats:p>Within the mTBI cohort, mortality was strongly associated with increasing age, higher ASA category, and greater intracranial injury severity. After adjustment for age and injury-related variables, ASA class remained independently associated with 30-day mortality. Specifically, compared to ASA 1 patients, those with ASA 2 had 2.8 times higher odds of 30-day mortality, ASA 3 patients had 4.3 times higher odds, and ASA 4 patients had 21 times higher odds. A graded association between ASA class and mortality was also observed in the NTBI cohort, although the pattern of injury-related covariates differed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pre-injury health status, measured by the ASA class, was independently associated with 30-day mortality in patients with mild traumatic brain injury. Comparable associations in non-TBI trauma suggest that comorbidity and baseline health contribute substantially to early post-trauma mortality among awake trauma patients. ASA class may provide complementary information to traditional injury-based assessments, particularly in older patients, although further studies are needed to evaluate how such information can best inform clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-026-06900-9","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T06:03:12Z","timestamp":1778306592000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["ASA class is independently associated with 30-day mortality after mild traumatic brain injury with intracranial injury: a national retrospective cohort study"],"prefix":"10.1007","volume":"168","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3562-5513","authenticated-orcid":false,"given":"Olivia","family":"Kiwanuka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7674-3711","authenticated-orcid":false,"given":"Hans","family":"Pettersson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7416-4951","authenticated-orcid":false,"given":"Gabriel","family":"Sandblom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"6900_CR1","doi-asserted-by":"crossref","unstructured":"Anantha RV, Painter MD, Diaz-Garelli F, Nunn AM, Miller PR III, Chang MC et al (2021) Undertriage despite use of geriatric-specific trauma team activation guidelines: who are we missing? 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