Traumatic Brain Injury in Older Adults: Characteristics, Outcomes, and Considerations. Results From the American Association for the Surgery of Trauma Geriatric Traumatic Brain Injury (GERI-TBI) Multicenter Trial

Mira Ghneim, Division of Trauma, Critical Care and Acute Care Surgery, R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, Baltimore, MD, USA. Electronic address: mira.ghneim@som.umaryland.edu.
Karen Brasel, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
Roumen Vesselinov, Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA.
Jennifer Albrecht, Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA.
Anna Liveris, Division of Trauma, Critical Care and Acute Care Surgery, R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, Baltimore, MD, USA.
Jill Watras, Department of Trauma Services, Inova Fairfax Medical Campus, Falls Church, VA, USA.
Christopher Michetti, Department of Trauma Services, Inova Fairfax Medical Campus, Falls Church, VA, USA.
James Haan, Department of Surgery, Ascension Via Christi Hospital, Wichita, KS, USA.
Kelly Lightwine, Department of Surgery, Ascension Via Christi Hospital, Wichita, KS, USA.
Robert Winfield, Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
Sasha Adams, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
Jeanette Podbielski, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
Scott Armen, Departments of Surgery and Neurosurgery, Penn State Health System, Hershey, PA, USA.
J Christopher Zacko, Departments of Surgery and Neurosurgery, Penn State Health System, Hershey, PA, USA.
Fady Nasrallah, Department of Surgery, Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA.
Kathryn Schaffer, Department of Surgery, Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA.
Julie Dunn, Department of Surgery, Medical Center of the Rockies, Loveland, CO, USA.
Brittany Smoot, Department of Surgery, Medical Center of the Rockies, Loveland, CO, USA.
Thomas Schroeppel, Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, UC Health Memorial Hospital, Colorado Springs, CO, USA.
Zachery Stillman, Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, UC Health Memorial Hospital, Colorado Springs, CO, USA.
Zara Cooper, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Deborah Stein, Division of Trauma, Critical Care and Acute Care Surgery, R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, Baltimore, MD, USA.

Document Type

Article

Publication Title

Journal of the American Medical Directors Association

Abstract

OBJECTIVES: Describe the epidemiology of a large cohort of older adults with isolated traumatic brain injury (TBI) and identify predictors of mortality, palliative interventions, and discharge to preinjury residence in those presenting with moderate/severe TBI. DESIGN: Prospective observational study of geriatric patients with TBI enrolled across 45 trauma centers. SETTING AND PARTICIPANTS: Inclusion criteria were age ≥40 years, and computed tomography (CT)-verified TBI. Exclusion criteria were any other body region abbreviated injury scale score >2 and presentation at enrolling center >24 hours after injury. METHODS: The analysis was restricted to individuals aged ≥65 and stratified into 3 age groups: young-old (65-74), middle-old (75-84), and oldest-old (≥85). Demographic, clinical, and injury data were collected. Predictors of mortality, palliative interventions, and discharge to preinjury residence in the moderate/severe TBI group were identified using Classification and Regression Tree and Generalized Linear Mixed Models. RESULTS: Of the 3081 subjects enrolled in the study, 2028 were ≥65 years old. Overall, 339 (16.7%) presented with a moderate/severe TBI and experienced a 64% mortality rate. A Glasgow Coma Scale (GCS) score <9 was the main predictor of mortality, CT worsening (odds ratio [OR] = 1.7, P < .04), cerebral edema (OR = 2.4, P < .04), GCS <9, and age ≥75 (OR = 2.1, P = .007) were predictors for palliative interventions, and an injury severity score ≤24 (OR = 0.087, P = .002) was associated with increased likelihood of discharge to preinjury residence in the moderate/severe TBI group. CONCLUSION AND IMPLICATIONS: In this prospective study of a large cohort of older adults with isolated TBI, comparisons across the older age groups with moderate/severe TBI revealed that survival and favorable discharge disposition were influenced more by severity of injury rather than age itself. Indicating that chronological age alone maybe insufficient to accurately predict outcomes, and increased representation of older adults in TBI research to develop better diagnostic and prognostic tools is warranted.

First Page

568

Last Page

575.e1

DOI

10.1016/j.jamda.2022.01.085

Publication Date

4-1-2022

Identifier

35283084 (pubmed); 10.1016/j.jamda.2022.01.085 (doi); S1525-8610(22)00163-3 (pii)

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