Intensive Care Unit Utilization in Older Adult Traumatic Brain Injury Patients Following Ground-Level Falls: A Single-Center Retrospective Review.

BACKGROUND

Ground-level falls (GLFs) have become the leading cause of traumatic brain injury (TBI) in older adults, surpassing motor vehicle collisions over the last decade. Older adults with TBI frequently require intensive care unit (ICU) admission and need neurosurgical intervention. This study evaluates ICU utilization and clinical outcomes in older adults with TBI following GLFs.

METHODS

We conducted a single-center retrospective study of patients aged 60 years or older with radiographically confirmed TBI after a GLF during 2024. Multivariable Firth's penalized logistic regression evaluated factors associated with ICU admission and neurosurgical intervention.

RESULTS

Among 6202 trauma activations in 2024, 1288 (21%) involved GLFs. Of these, 237 patients (18%) sustained a TBI. Seventy-four patients (31%) were admitted to an ICU, and 27 (11%) underwent neurosurgical intervention. Each 1-point decrease in admission Glasgow Coma Scale score was associated with ICU admission (adjusted odds ratio [aOR], 1.53; 95% confidence interval [CI], 1.20-2.06; P < 0.001), as was each 5-point increase in Injury Severity Score (aOR, 2.08; 95% CI, 1.60-2.76; P < 0.001). Each 5-point increase in Injury Severity Score was also associated with neurosurgical intervention (aOR, 2.17; 95% CI, 1.53-3.15; P < 0.001). Seven patients (3.0%) died during hospitalization, and 131 (55%) were discharged home or with home health services.

CONCLUSIONS

Nearly one third of older adults with GLF-related TBI required ICU admission. Lower admission Glasgow Coma Scale score and greater injury severity were associated with ICU admission, whereas injury severity was associated with neurosurgical intervention. This underscores the importance of early identification, multidisciplinary care coordination, and ICU resource planning for the aging trauma population. Preventive strategies and improved risk stratification tools are urgently needed as the incidence of GLF-related TBI continues to rise.