Age Matters: Unveiling the Impact of Traumatic Brain Injury Size and Type on Outcomes in Middle-Aged and Elderly Patients.

Background: Traumatic brain injury (TBI) is a major cause of morbidity and mortality in older adults. While age and severity are known predictors of outcomes, limited research exists on how specific TBI types and sizes affect prognosis in older age groups.Methods: A retrospective cohort study analyzed data from the American College of Surgeons Trauma Quality Programs Participant Use File (ACS-TQIP-PUF) (2017-2022) including 182,661 adults ≥40 years with isolated blunt TBI (subdural hematoma >8mm, epidural hematoma >8mm, contusion >2cm, subarachnoid hemorrhage, or diffuse axonal injury [DAI]) and no skull fractures. Polytrauma cases were excluded. Outcomes included in-hospital mortality, intensive care unit (ICU) length of stay (LOS), and ventilator days. Multivariable logistic and linear regression models were used, adjusting for demographic, clinical, and injury characteristics.Results: Elderly patients (≥65 years) showed significantly higher mortality across all TBI types, most notably with contusions >2cm (OR 4.85, 95% CI 3.46-6.80, P<.01). DAI in elderly patients was associated with the longest ICU LOS (+2.63 days, 95% CI 1.76-3.49, P<.01) and ventilator duration (+4.29 days, 95% CI 1.90-6.67, P<.01). Factors such as anticoagulation use, low Glasgow Coma Scores, and specific comorbidities further increased risk.Conclusions: Older adults with larger, isolated TBIs, especially contusions and DAI, experience worse clinical outcomes. These findings underscore the critical need for age-tailored trauma management protocols and early intervention strategies to reduce mortality and improve recovery in this vulnerable population.