Prognostic value of the Braden scale for short-term mortality in critically ill patients with traumatic brain injury.

Traumatic brain injury (TBI) is a leading cause of global mortality and disability. Early identification of mortality risk factors is crucial for improving outcomes. The Braden Scale score, a routinely collected nursing assessment tool originally designed for pressure injury risk assessment, has been underexplored for mortality prediction in TBI patients. This study aimed to evaluate the association between Braden Scale scores at ICU admission and short-term all-cause mortality in TBI patients. This retrospective cohort study utilized the MIMIC-IV database as the derivation cohort and the eICU-CRD database for external validation. Adult TBI patients with complete Braden Scale assessments and outcome data were included. The primary exposure was the initial Braden Scale score, categorized into low and high groups based on the median value. Outcomes included 28 days and 60 days all-cause mortality in both hospital and ICU settings. We also evaluate the components of braden scores by cox regression for outcoms. Statistical analyses included multivariable Cox regression, restricted cubic splines, subgroup analyses, and assessments of predictive performance using IDI, NRI, ROC curves, and decision curve analysis. A total of 2355 patients were analyzed. The low Braden score group showed significantly higher mortality across all endpoints: hospital 28 days (48.1% vs. 19.7%), hospital 60 days (49.4% vs. 20.7%), ICU 28 days (46.2% vs. 18.9%), and ICU 60 days (47.6% vs. 19.8%) (all p < 0.001). After multivariable adjustment, low Braden scores remained independently associated with mortality, with adjusted hazard ratios ranging from 1.78 to 1.84. In a cox regression analysis for the components of Braden Scale, we identified significant inverse associations of sensory perception, activity, nutrition, and friction/shear with multiple mortality outcomes. A nonlinear dose-response relationship was observed, with mortality risk increasing sharply at scores below 12-15. Subgroup analyses indicated a more pronounced association in patients aged ≤ 65 years, while the association was attenuated in those with renal disease. The Braden score demonstrated robust discriminative ability (AUCs: 0.77-0.82) and clinical utility in decision curve analysis. The Braden Scale score is a strong, independent, and readily available predictor and risk factor of short-term mortality in TBI patients, demonstrating a nonlinear inverse relationship with death risk. Subitem analysis further identified sensory perception, activity, nutrition, and friction/shear as key components significantly associated with reduced mortality. These properties support its practical utility for risk stratification at the bedside.