Long-Term Outcomes after Severe Traumatic Brain Injury in Older Adults. A Registry-based Cohort Study

• Published in: American journal of respiratory and critical care medicine 2020-01, Vol.201 (2), p.167-177
• Main Authors: Maiden, Matthew J, Cameron, Peter A, Rosenfeld, Jeffrey V, Cooper, D James, McLellan, Susan, Gabbe, Belinda J
• Format: Article
• Language: English
• Subjects: Abbreviated Injury Scale; Accidental Falls; Accidents, Traffic; Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Brain Contusion - mortality; Brain Contusion - physiopathology; Brain Contusion - therapy; Brain Injuries, Diffuse - physiopathology; Brain Injuries, Traumatic - mortality; Brain Injuries, Traumatic - physiopathology; Brain Injuries, Traumatic - therapy; Cerebral Hemorrhage, Traumatic - mortality; Cerebral Hemorrhage, Traumatic - physiopathology; Cerebral Hemorrhage, Traumatic - therapy; Cerebral Intraventricular Hemorrhage - mortality; Cerebral Intraventricular Hemorrhage - physiopathology; Cerebral Intraventricular Hemorrhage - therapy; Clinical outcomes; Cohort analysis; Cohort Studies; Female; Glasgow Outcome Scale; Hematoma, Subdural - mortality; Hematoma, Subdural - physiopathology; Hematoma, Subdural - therapy; Hospital Mortality; Hospitalization; Humans; Injury Severity Score; Intensive Care Units; Male; Mortality; Neurosurgical Procedures; Odds Ratio; Older people; Registries; Respiration, Artificial; Skull Fractures - mortality; Skull Fractures - physiopathology; Skull Fractures - therapy; Subarachnoid Hemorrhage, Traumatic - mortality; Subarachnoid Hemorrhage, Traumatic - physiopathology; Subarachnoid Hemorrhage, Traumatic - therapy; Tracheostomy; Traumatic brain injury; Victoria
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201903-0673OC

Older adults (≥65 yr old) account for an increasing proportion of patients with severe traumatic brain injury (TBI), yet clinical trials and outcome studies contain relatively few of these patients. To determine functional status 6 months after severe TBI in older adults, changes in this status over 2 years, and outcome covariates. This was a registry-based cohort study of older adults who were admitted to hospitals in Victoria, Australia, between 2007 and 2016 with severe TBI. Functional status was assessed with Glasgow Outcome Scale Extended (GOSE) 6, 12, and 24 months after injury. Cohort subgroups were defined by admission to an ICU. Features associated with functional outcome were assessed from the ICU subgroup. The study included 540 older adults who had been hospitalized with severe TBI over the 10-year period; 428 (79%) patients died in hospital, and 456 (84%) died 6 months after injury. There were 277 patients who had not been admitted to an ICU; at 6 months, 268 (97%) had died, 8 (3%) were dependent (GOSE 2-4), and 1 (0.4%) was functionally independent (GOSE 5-8). There were 263 patients who had been admitted to an ICU; at 6 months, 188 (73%) had died, 39 (15%) were dependent, and 32 (12%) were functionally independent. These proportions did not change over longer follow-up. The only clinical features associated with a lower rate of functional independence were Injury Severity Score ≥25 (adjusted odds ratio, 0.24 [95% confidence interval, 0.09-0.67];  = 0.007) and older age groups (  = 0.017). Severe TBI in older adults is a condition with very high mortality, and few recover to functional independence.