After TBI, 6-month mortality is 1 in 5 among elderly patients

  • Nishijima DK & al.
  • Acad Emerg Med
  • 9 ene. 2020

  • de Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Among elderly adults with traumatic brain injury (TBI), 6-month mortality is high.
  • Authors: “routine trauma center transport in this patient population may not be necessary.”

Why this matters

  • Elderly people are more vulnerable to TBI.

Key results

  • Median age, 70 years.
  • Most common mechanism: fall from standing height or higher.
  • 73% were transferred to a Level 1 or 2 trauma center.
  • At 6-month follow-up:
    • 46% (119/260) had at least moderate disability.
    • 21% (55/260) had died.
    • 55% of those deaths were because of illness or non-head injury.
  • Worse 6-month Extended Glasgow Outcome Scale (GOS-E) scores correlated with:
    • Abnormal Glasgow Coma Scale score.
    • More comorbidities.
    • Traumatic intracranial hemorrhage on initial emergent imaging.
  • Transport to trauma center was not associated with 6-month GOS-E scores in either the general study population or a subset with traumatic intracranial hemorrhage.

Study design

  • Prospective observational study, California, comprising 5 single-county emergency medical services (EMS) agencies and 11 hospitals.
  • Participants were adults ≥55 years with TBI transported to a hospital by EMS (n=350). 
  • Outcomes: Function at 3 and 6 months per GOS-E, via telephone follow-up.
  • Funding: CDC.

Limitations

  • 25% lost to follow-up.
  • Few required neurosurgery, limiting ability to estimate benefit of transfer in that subgroup.