M. Khan1, A. Azim1, T. O’Keeffe1, L. Gries1, K. Ibraheem1, A. Tang1, G. Vercruysse1, R. Friese1, B. Joseph1 1University Of Arizona,Trauma And Surgical Critical Care/Department Of Surgery,Tucson, AZ, USA
Introduction:
As the population ages, increasing number of elderly patients sustain traumatic brain injury (TBI). Communication of accurate prognostic information plays a crucial role in informed decision making for these patients. The aim of our study was to develop a simple and clinically applicable tool that accurately predicts the prognosis in geriatric TBI patients
Methods:
One-year (2011) retrospective analysis of geriatric TBI patients (h-AIS≥3 and age≥65) in the National Trauma Data Bank was performed and patients dead on arrival were excluded. We defined and calculated a GCS and Age Prognosis (GAP) score (Age/GCS score) for all patients. Our outcome measures were mortality and discharge disposition (Home versus Rehab/SNiF). ROC analysis was performed to determine the discriminatory power of GAP score.
Results:
A total of 8,750 geriatric patients with TBI were included. Mean age was 77.8± 7.1 years, median [IQR] GCS was 15 [14-15], and median [IQR] head-AIS was 4[3-4]. Overall mortality rate was 14.1% and 42.7% patients were discharged home. As the GAP score increased, mortality rate increased and discharge to home decreased. ROC analysis revealed excellent an discriminatory power for mortality (AUC: 0.826). Above a GAP score of 12, mortality rate was greater than 60%, more than 35% patients were discharged to Rehab/SNif and less than 5% of patients were discharged home.
Conclusion:
For geriatric patients with TBI, a simple GAP score reliably predicts outcomes. A score above 12 results in drastic increase in mortality and adverse discharge disposition. This simple tool may help clinicians provide accurate prognostic information to patient families.
