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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

2022; Elsevier BV; Volume: 23; Issue: 4 Linguagem: Inglês

10.1016/j.jamda.2022.01.085

1538-9375

Mira Ghneim, Karen J. Brasel, Roumen Vesselinov, Jennifer S. Albrecht, Anna Liveris, Jill Watras, Christopher P. Michetti, James M. Haan, Kelly Lightwine, Robert D. Winfield, Sasha D. Adams, Jeanette M. Podbielski, Scott B. Armen, J. Christopher Zacko, Fady Nasrallah, Kathryn B. Schaffer, Julie Dunn, Brittany Smoot, Thomas J. Schroeppel, Zachery Stillman, Zara Cooper, Deborah M. Stein, Charles A. Adams, Stephanie Lueckelm, Jason Murry, Cindy H. Hsu, Umer Bhatti, Matthew Lissauer, Marc LaFonte, Kaveh Najafi, Karen Lewandowski, Kaushik Mukherjee, Kristelle Imperio-Lagabon, Niels D. Martin, Kathleen Hirsch, Cherisse Berry, Derek Freitas, Daniel C. Cullinane, Roshini Ramwani, Michael S. Truitt, Chris Pearcy, Habiba Hashimi, Krista L. Kaups, Jeffry Claridge, Husayn A. Ladhani, Jennifer L. Hartwell, Jessica Ballou, Martin A. Croce, Stephanie Markle, Sally Osserwaarde, Joseph A. Posluszny, Benjamin Stocker, Tjasa Hranjec, Rachele Solomon, Lucy Martinek, Alok Gupta, Daniel Grabo, Uzer Khan, Danielle Tatum, Tomas Jacome, Jonathan D. Gates, Alisha Jawani, Allison E. Berndtson, Terry Curry, Miklosh Bala, Linda A. Dultz, Natasha Houshmand, Paola G. Pieri, Martin D. Zielinski, Joy Hughes, Jennifer L. Hartwell, Ajai K. Malhotra, Tim Lee, Patrizio Petrone, D’Andrea K. Joseph, Gary T. Marshall, Matthew Carrick, Abhijit Pathak, Andrea Van Zandt, Nina E. Glass, David H. Livingston, Shea C. Gregg, Travis P. Webb, Byron C. Drumheller, Rosemary A. Kozar, Robert D. Barraco, Bellal Joseph,

Traumatic Brain Injury Research

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.