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; Karen Brasel; Roumen Vesselinov; Jennifer Albrecht; Anna Liveris; Jill Watras; Christopher Michetti; James Haan; Kelly Lightwine; Robert Winfield; Sasha Adams; Jeanette Podbielski; Scott Armen; J Christopher Zacko; Fady Nasrallah; Kathryn Schaffer; Julie Dunn; Brittany Smoot; Thomas Schroeppel; Zachery Stillman; Zara Cooper; Deborah Stein; Additional Study Group Members of The American Association for the Surgery of Trauma Geri-TBI Study

doi:10.1016/j.jamda.2022.01.085

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

J Am Med Dir Assoc. 2022 Apr;23(4):568-575.e1. doi: 10.1016/j.jamda.2022.01.085. Epub 2022 Mar 10.

Authors

Mira Ghneim¹, Karen Brasel², Roumen Vesselinov³, Jennifer Albrecht³, Anna Liveris⁴, Jill Watras⁵, Christopher Michetti⁵, James Haan⁶, Kelly Lightwine⁶, Robert Winfield⁷, Sasha Adams⁸, Jeanette Podbielski⁸, Scott Armen⁹, J Christopher Zacko⁹, Fady Nasrallah¹⁰, Kathryn Schaffer¹⁰, Julie Dunn¹¹, Brittany Smoot¹¹, Thomas Schroeppel¹², Zachery Stillman¹², Zara Cooper¹³, Deborah Stein⁴; Additional Study Group Members of The American Association for the Surgery of Trauma Geri-TBI Study

Collaborators

Additional Study Group Members of The American Association for the Surgery of Trauma Geri-TBI Study:
Charles Adams¹⁴, Stephanie Lueckelm¹⁴, Jason Murry¹⁵, Cindy Hsu¹⁶, Umer Bhatti¹⁶, Matthew Lissauer¹⁷, Marc LaFonte¹⁷, Kaveh Najafi¹⁸, Karen Lewandowski¹⁸, Kaushik Mukherjee¹⁹, Kristelle Imperio-Lagabon¹⁹, Niels Martin²⁰, Kathleen Hirsch²⁰, Cherisse Berry²¹, Derek Freitas²¹, Daniel Cullinane²², Roshini Ramwani²², Michael Truitt²³, Chris Pearcy²³, Habiba Hashimi²⁴, Krista Kaups²⁴, Jeffry Claridge²⁵, Husayn Ladhani²⁵, Jennifer Hartwell²⁶, Jessica Ballou²⁷, Martin Croce², Stephanie Markle²⁸, Sally Osserwaarde²⁸, Joseph Posluszny²⁹, Benjamin Stocker²⁹, Tjasa Hranjec³⁰, Rachele Solomon³⁰, Lucy Martinek³¹, Alok Gupta³¹, Daniel J Grabo³², Uzer Khan³², Danielle Tatum³³, Tomas Jacome³³, Jonathan Gates³⁴, Alisha Jawani³⁴, Allison Berndtson³⁵, Terry Curry³⁵, Miklosh Bala³⁶, Linda Dultz³⁷, Natasha Houshmand³⁷, Paola Pieri³⁸, Martin Zielinski³⁹, Joy Hughes³⁹, Jennifer Hartwell⁴⁰, Ajai Malhotra⁴¹, Tim Lee⁴¹, Patrizio Petrone⁴², D'andrea Joseph⁴², Gary Marshall⁴³, Matthew Carrick⁴³, Abhijit Pathak⁴⁴, Andrea Van Zandt⁴⁴, Nina Glass⁴⁵, David Livingston⁴⁵, Shea Gregg⁴⁶, Travis Webb⁴⁷, Byron Drumheller⁴, Rosemary Kozar⁴, Robert Barraco⁴⁸, Bellal Joseph⁴⁹

Affiliations

¹ 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.
² Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
³ Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA.
⁴ Division of Trauma, Critical Care and Acute Care Surgery, R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, Baltimore, MD, USA.
⁵ Department of Trauma Services, Inova Fairfax Medical Campus, Falls Church, VA, USA.
⁶ Department of Surgery, Ascension Via Christi Hospital, Wichita, KS, USA.
⁷ Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
⁸ Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
⁹ Departments of Surgery and Neurosurgery, Penn State Health System, Hershey, PA, USA.
¹⁰ Department of Surgery, Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA.
¹¹ Department of Surgery, Medical Center of the Rockies, Loveland, CO, USA.
¹² Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, UC Health Memorial Hospital, Colorado Springs, CO, USA.
¹³ Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
¹⁴ Department of Surgery, Division of Trauma and Surgical Critical Care, Rhode Island Hospital, Providence, RI, USA.
¹⁵ Department of Surgery, University of Texas Health Science Center at Tyler, Tyler, TX, USA.
¹⁶ Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
¹⁷ Department of Surgery, Rutgers-Robert Wood Johnson Medical School, Clinical Academic Building, New Brunswick, NJ, USA.
¹⁸ Department of Surgery, Honor Health Scottdale Osborn Medical Center, Scottsdale, AZ, USA.
¹⁹ Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
²⁰ Department of Surgery, Division of Trauma and Surgical Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
²¹ Department of Surgery, Division of Acute Care Surgery, New York University/Bellevue Hospital Center, New York, NY, USA.
²² Department of Surgery, Marshfield Clinic, Marshfield, WI, USA.
²³ Department of Surgery, Methodist Dallas Medical Center, Dallas, TX, USA.
²⁴ Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA.
²⁵ Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA.
²⁶ Department of Surgery, Indiana University Department of Surgery, IU Health Methodist Hospital, Indianapolis, IN, USA; Department of Surgery, Indiana University at Eskenazi Health, Indianapolis, IN, USA.
²⁷ Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, OR, USA.
²⁸ Department of Surgery, Ascension Borgess, Kalamazoo, MI, USA.
²⁹ Department of Surgery, Division of Trauma and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
³⁰ Department of Surgery, Division of Trauma and Acute Care Surgery, Memorial Regional Hospital, Hollywood, FL, USA.
³¹ Department of Surgery, Division of Trauma and Surgical Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
³² Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, West Virginia University, Morgantown, WV, USA.
³³ Department of Surgery, Division of Trauma, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA.
³⁴ Department of Surgery, Hartford Hospital, Hartford, CT, USA.
³⁵ Department of Surgery, Division of Trauma, Surgical Critical Care, Burn and Acute Care Surgery, University of California San Diego, La Jolla, CA, USA.
³⁶ Department of Surgery, Division of Trauma and Acute Care Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
³⁷ Department of Surgery, Division of Burn, Trauma and Surgical Critical Care, The University of Texas Southwestern Medical Center, Parkland Hospital, Dallas, TX, USA.
³⁸ Department of Surgery, Division of Trauma and Surgical Critical Care, Maricopa Integrated Health Systems, Phoenix, AZ, USA.
³⁹ Department of Surgery, Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA.
⁴⁰ Department of Surgery, Indiana University at Eskenazi Health, Indianapolis, IN, USA.
⁴¹ Department of Surgery, Division of Acute Care Surgery, University of Vermont, Burlington, Burlington, VT, USA.
⁴² Department of Surgery, New York University Winthrop Hospital, Mineola, NY, USA.
⁴³ Department of Surgery, Medical Center Plano, Plano, TX, USA.
⁴⁴ Department of Surgery, Temple University Hospital, Philadelphia, PA, USA.
⁴⁵ Department of Surgery, Division of Trauma and Surgical Critical Care, Rutgers Medical School University Hospital, Newark, NJ, USA.
⁴⁶ Department of Surgery, Bridgeport Hospital, Bridgeport, CT, USA.
⁴⁷ Department of Surgery, Medical College of Wisconsin, Wauwatosa, WI, USA.
⁴⁸ Department of Surgery, Division of Trauma, University of San Francisco-Lehigh Valley, Allentown, PA, USA.
⁴⁹ Department of Surgery, Division of Trauma, Burn and Acute Care Surgery, The University of Arizona, Tucson, AZ, USA.

PMID: 35283084
DOI: 10.1016/j.jamda.2022.01.085

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.

Keywords: Geriatric; moderate/severe TBI; mortality; older adults; palliative interventions; traumatic brain injury.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Brain Injuries, Traumatic*
Glasgow Coma Scale
Humans
Prognosis
Prospective Studies
Trauma Centers
United States / epidemiology