A. M. Velez1, S. G. Frangos2, C. J. DiMaggio2,3, C. D. Berry2, M. Bukur2 1New York University School Of Medicine,Department Of Surgery,New York, NY, USA 2New York University School Of Medicine,Department Of Surgery, Division Of Trauma And Acute Care Surgery,New York, NY, USA 3New York University School Of Medicine,Department Of Population Health,New York, NY, USA
Introduction: Accidents causing Traumatic Brain Injury (TBI) are common in the elderly. Hospitals frequently transfer these patients to designated Trauma Centers (TC) for management. Recent studies have suggested some of these injuries may be safely observed or even discharged from the Emergency Department, an issue that has not been evaluated on a national level. The objective of this study was to examine whether TC transfer of elderly patients with mild TBI is associated with improved outcomes.
Methods: This was a retrospective study utilizing the National Trauma Databank 2015 dataset. Patients over 65 years of age who suffered injuries resulting in mild TBI (positive Head CT and GCS ≥13) were included. Demographic, injury, and outcomes data were abstracted. Patients were dichotomized by transfer to a designated Level I/II TC vs. not. Multivariate regression was used to derive adjusted outcomes for our primary outcome of mortality. Secondary outcomes assessed were complications and discharge disposition.
Results: 19,664 patients met inclusion criteria with a mean age of 78.1 years. 70% of patients were transferred to a Level I/II TC with the remainder treated at lower tier or non-designated centers. Only 4.2% of transfers came from centers without neurosurgeons, while 80% of transferring centers had > 3 neurosurgeons. Patients transferred to Level I/II TCs were more likely to be Caucasian and have Medicare funding. Falls were the predominant cause of injury with Median Head AIS (4) and GCS (15) being similar between groups. Patients transferred to Level I/II TCs had a higher ISS (12 vs. 10, p <0.001). No neurosurgical interventions were required in any of the patients. Mortality was significantly lower in patients transferred to Level I/II TCs (5.6% vs. 6.2%, Adjusted Odds Ratio (AOR) 0.84, p=0.011). Patients treated at Level I/II TCs were also less likely to be discharged to Skilled Nursing Facilities (26.4% vs. 30.2%, AOR 0.80, p <0.001).
Conclusion: In a large, multi-center sample we demonstrate improved outcomes when elderly patients with mild TBI are transferred to Level I/II TCs. These findings suggest elderly patients with mild TBI are a heterogeneous group that warrants appropriate trauma triage. Which patients with mild TBI require Level I/II TC care should be examined prospectively.