Isolated Traumatic Brain Injury: Age Is an Independent Predictor of Mortality and Early Outcome

TLDR

Geriatric trauma patients experience worse outcomes than younger patients with comparable injuries, yet the specific impact of traumatic brain injury on this increased mortality remains unclear. This study aimed to determine whether age independently predicts mortality and early outcomes in patients with isolated traumatic brain injury. A retrospective analysis of 694 adults with isolated TBI (AIS ≥ 3) admitted over five years to two Level I trauma centers compared mortality, Glasgow Outcome Scale scores, therapies, and complications between elderly (≥ 65 yr) and younger patients. Elderly patients had twice the mortality of younger patients (30% vs 14%) and higher rates of poor functional outcome (13% vs 5%), with age and Glasgow Coma Scale score independently associated with mortality across all injury severities.

Abstract

Geriatric trauma patients have a worse outcome than the young with comparable injuries. The contribution of traumatic brain injury (TBI) to this increased mortality is unknown and has been confounded by the presence of other injuries. The purpose of this study was to investigate the role of age in the mortality and early outcome from isolated TBI.This was a retrospective analysis of all adult patients with isolated TBI (Abbreviated Injury Scale score > or = 3) admitted during a 5-year period to two Level I trauma centers. Mortality, Glasgow Outcome Scale score at discharge, therapy, and complications were compared for elderly (age > or = 65 years) and younger patients.Of 694 patients, 22% were defined as elderly. The mortality for the elderly group was twice that of their younger counterparts (30% vs. 14%, p < 0.001), even for those with mild to moderate TBI (Glasgow Coma Scale score of 9-15). Thirteen percent of elderly survivors had a poor functional outcome (Glasgow Outcome Scale score of 2 or 3) at hospital discharge versus 5% in the young group (p < 0.01). Independent factors associated with a high mortality were age and Glasgow Coma Scale score.The mortality from TBI is higher in the geriatric population at all levels of head injury. In addition, functional outcome at hospital discharge is worse. Although some of this increased mortality may be explained by complications or type of head injury, age itself is an independent predictor for mortality in TBI.