The American journal of emergency medicine · 2025
Outcomes of adult & geriatric trauma patients with severe traumatic brain injury treated at level I or II ACS-verified trauma centers: Towards optimizing geriatric trauma care.
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Nunes Nikita, Nasef Hazem, Baum Samuel, Kumar Sarthak, Werling Alaina, Patel Heli, Hersperger Stephen G, Elkbuli Adel
Аннотация
INTRODUCTION: This study aims to evaluate clinical outcomes among geriatric and adult trauma patients with severe isolated traumatic brain injury (TBI) treated at Level I and II American College of Surgeons (ACS) verified trauma centers.
METHODS: This retrospective cohort study analyzed the ACS Trauma Quality Improvement Program (TQIP) database from 2017 to 2023. Geriatric (age ≥ 65) and adult (age 18-64) trauma patients with severe isolated TBI (Glasgow coma scale (GCS) ≤8, AIS head ≥3, AIS <3 all other body regions) treated at ACS-verified Level I or II trauma centers were included. Primary study outcomes included in-hospital mortality in addition to rates of neurosurgical intervention and intracranial pressure monitoring. Secondary outcomes included rates of early tracheostomy, intensive care unit length-of-stay (ICU-LOS), complications, and discharge disposition.
RESULTS: There was a total of 18,621 patients included in this analysis, with 7780 (41.9 %) geriatric patients and 10,841 (58.2 %) adult patients. At level I trauma centers, geriatric patients had 82 % significantly lower odds of in-hospital mortality (OR 0.180, 95 % CI 0.114-0.284, p < 0.001) and adults had 79 % significantly lower odds of in-hospital mortality (OR 0.205, 95 % CI 0.139-0.301, p < 0.001). However, geriatric patients had 46 % significantly lower odds of neurosurgical intervention (OR 0.535, 95 % 0.333-0.859, p = 0.010) and an ICU-LOS of 1.9 days significantly longer (B = 1.875, 95 % CI 0.634-3.117, p = 0.003), while adults had 79 % significantly lower odds of neurosurgical intervention (OR 0.214, 95 % 0.165-0.277, p < 0.001) and an ICU-LOS of 1.4 days significantly shorter (B = -1.415, 95 % CI -2.187 to -0.644, p < 0.001).
CONCLUSION: Following severe isolated TBI, geriatric trauma patients experience similar mortality to adult patients at both level I and II trauma centers, but at the expense of higher odds of neurosurgical intervention, complications, prolonged ICU-LOS, and less favorable discharge disposition.
METHODS: This retrospective cohort study analyzed the ACS Trauma Quality Improvement Program (TQIP) database from 2017 to 2023. Geriatric (age ≥ 65) and adult (age 18-64) trauma patients with severe isolated TBI (Glasgow coma scale (GCS) ≤8, AIS head ≥3, AIS <3 all other body regions) treated at ACS-verified Level I or II trauma centers were included. Primary study outcomes included in-hospital mortality in addition to rates of neurosurgical intervention and intracranial pressure monitoring. Secondary outcomes included rates of early tracheostomy, intensive care unit length-of-stay (ICU-LOS), complications, and discharge disposition.
RESULTS: There was a total of 18,621 patients included in this analysis, with 7780 (41.9 %) geriatric patients and 10,841 (58.2 %) adult patients. At level I trauma centers, geriatric patients had 82 % significantly lower odds of in-hospital mortality (OR 0.180, 95 % CI 0.114-0.284, p < 0.001) and adults had 79 % significantly lower odds of in-hospital mortality (OR 0.205, 95 % CI 0.139-0.301, p < 0.001). However, geriatric patients had 46 % significantly lower odds of neurosurgical intervention (OR 0.535, 95 % 0.333-0.859, p = 0.010) and an ICU-LOS of 1.9 days significantly longer (B = 1.875, 95 % CI 0.634-3.117, p = 0.003), while adults had 79 % significantly lower odds of neurosurgical intervention (OR 0.214, 95 % 0.165-0.277, p < 0.001) and an ICU-LOS of 1.4 days significantly shorter (B = -1.415, 95 % CI -2.187 to -0.644, p < 0.001).
CONCLUSION: Following severe isolated TBI, geriatric trauma patients experience similar mortality to adult patients at both level I and II trauma centers, but at the expense of higher odds of neurosurgical intervention, complications, prolonged ICU-LOS, and less favorable discharge disposition.