A. Azim1, K. Prabhakaran1, D. Samson1, G. Lombardo1, J. Con1, A. El-Menyar1, R. Latifi1 1Westchester Medical Center,Surgery,Valhalla, NY, USA
Introduction: Pneumonia, Acute Respiratory Distress Syndrome(ARDS) and Acute Kidney Injury (AKI) are common in elderly trauma patients. Presence pf these comorbidities in severe Traumatic Brain Injury (sTBI) patients makes clinical course more complicated. The aim of this study was to review the factors that influence outcomes in patients with sTBI.
Methods: All trauma patients ≥ 65 years old with sTBI (GCS ≤8) identified in the trauma registry of our Level I ACS verified trauma center during 2011-2016 were studied. Data points including Injury characteristics, demographics, comorbidities were collected and analyzed. Previously validated 11 variable modified frailty index (mFI) as utilized to calculate frality status. Outcome variables included death and complications.
Results: There were 194 patients; 55.2% age 65-79 years (Group I) and 44.8% age >80(Group II). Modified Frailty Index(mFI) scores were ≥3 in 36 (18.6%). The injury severity score(ISS) was ≥25 in 56.7%. Older patients had abbreviated injury score (AIS) head > 3 (71.3% for ≥80 and 56.1% for 65-79, p=0.036), and cirrhosis of the liver (19.5% for ≥80 versus 4.7% for 65-79, p=0.001). 64.4% of patients ≥80 and 45.8% of patients 65-79, (p=0.01) died. Patients with higher frailty score had an increased probability of experiencing acute kidney injury(AKI) (6.3% for mFI 0-2 versus 25% for mFI ≥3, p=0.002) as well as acute respiratory distress syndrome(ARDS) (22.8% for mFI 0-2 versus 38.9% for mFI ≥3, p=0.046). In subgroup analysis, mortality was significantly more likely in the mFI 0-2/age ≥80 group (68.1%) than in the mFI 0-2/age 65-79 group (45.1%, p=0.036). Older non-frail patients were less likely to experience AKI than younger more frail patients: 5.8% for mFI 0-2/age ≥80 versus 27.8% for mFI ≥3/age 65-79 (p=0.013) (see Table 1).
Conclusions: Age is associated with increased mortality, whereas frailty is associated with increased complications (particularly AKI) in this patient population. Identification of frailty status of the patient can help in risk startification and appropriate resource allocation in patients resulting in better outcomes in severe TBI patients
