A. Caiado1, S. Armen1, R. Staszak1, J. Chandler1, K. Fitzgerald1, S. Allen1 1Penn State Hershey Medical Center,Hershey, PA, USA
Introduction: A significant amount of attention has been given to the identification and consequences related to mild traumatic brain injury (mTBI) or concussion among young athletes and combat veterans. The interest in concussion is the result of the insidious yet devastating long-term sequelae of these seemingly minor head injuries. The effects of concussion among the elderly are largely unstudied; furthermore, the incidence and identification of concussions in this age group is not well delineated. The goal of this study was to investigate the incidence of the diagnosis of concussion among the elderly population as compared to an injury matched younger cohort. We hypothesized that elderly patients who meet criteria for the diagnosis of a concussion are under-diagnosed compared to a younger, injury matched cohort.
Methods: The trauma registry of an academic Level 1 trauma center was retrospectively queried over a 2 year study period. Adult patients (>18 years of age) with an abbreviated injury score (AIS) head of 1-2 from a blunt mechanism of injury and who met criteria for mTBI as set forth by the American Association of Neurosurgeons (AANS) were evaluated. Demographic information, as well as Glasgow coma score (GCS), the GCS motor score (MS), injury severity score (ISS), blood alcohol concentration (BAC), ICU length of stay, and hospital length of stay were studied. The charts of all patients were queried for the specific diagnoses of mTBI or concussion (n=618). An older cohort (>65 years of age) (n=231) was then compared to a younger cohort (18-64 years) (n=387) matched on MS, GCS and ISS. The difference in the incidence of the diagnosis of concussion was calculated. Chi-squared tests as well as student’s t-tests were used for statistical analysis as appropriate.
Results:There was a steady and statistically significant decrease in the incidence of the diagnosis of concussion across the older decades of life. Nearly 90% of patients 18-24 years of age were diagnosed with concussion as compared to just over 50% of those over the age of 75 years and is inversely related to the incidence pre-existing dementia. There were no differences in ISS, MS and GCS among the two study groups. Concussion was formally diagnosed significantly less in older patients as compared to the injury matched younger group.
Conclusion:Mild traumatic brain injuries are common among patients who sustain blunt injuries. However, while younger patients are frequently diagnosed with concussion, only 50% of elderly adults who meet criteria for mTBI are formally diagnosed with concussion. The failure to recognize this ubiquitous injury among the elderly may lead to less interventions and significantly poorer long-term outcomes, especially in those with a prior history of dementia. Future studies should focus on early and aggressive interventions for concussion in the elderly in an effort to mitigate the negative sequelae of these injuries and improve quality of life.