Predictors of early neurological deterioration and 6-month outcome in older adults with moderate traumatic brain injury.

INTRODUCTION

To analyze the epidemiologic characteristics of older adults with moderate traumatic brain injury (moderate TBI) and identify independent predictors for early neurological deterioration and unfavorable outcomes.

METHODS

Clinical data of 93 consecutive older adults (age ≥65 years) with moderate TBI (Glasgow Coma Scale [GCS] 9-12) admitted to Tangdu Hospital (2015-2020) were retrospectively analyzed. Multivariable logistic regression was performed to determine factors associated with early neurological deterioration (GCS decrease ≥2 points) and unfavorable outcome (Extended Glasgow Outcome Scale 1-4) at 6 months.

RESULTS

The median age was 69 years (72.0% male). Traffic accidents (46.0%) and falls (41.0%) were the leading mechanisms. Early neurological deterioration occurred in 35 patients (37.6%), and 26 patients (28.0%) had an unfavorable outcome at 6 months. Multivariable analysis revealed that lower platelet count, older age, lower admission GCS, and presence of subdural hematoma (SDH) were independently associated with early neurological deterioration. Furthermore,higher Charlson Comorbidity Index (CCI), older age, lower GCS, and the need for mechanical ventilation were independently associated with unfavorable outcome.

CONCLUSION

Moderate TBI in older adults is a distinct clinical entity with a high risk of deterioration. Beyond initial neurological status, systemic vulnerability markers, including lower platelet count and higher comorbidity burden, were associated with deterioration and unfavorable outcome and may help refine early risk stratification. Management strategies should integrate geriatric risk stratification and multidisciplinary care to improve functional outcomes.