S. Mansour1,2, A. A. Fokin2, A. Zuviv2, J. Wycech2,3, M. Crawford2, A. Tymchak1,2,3, I. Puente1,2,3,4 1Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA 2Delray Medical Center,Trauma Services,Delray Beach, FL, USA 3Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 4Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA
Introduction:
Geriatric patients are at increased risk for falling and sustaining traumatic brain injuries (TBI) than their non-geriatric counterparts. It has been shown that elderly patients may have cerebral atrophy that may in turn affect outcomes of intracranial hemorrhage; however this claim has not been studied adequately in TBI patients. We hypothesized that patients with pre-injury cerebral atrophy would have lower morbidity associated with TBI due to increased volume available for hematoma expansion.
Methods:
This IRB approved retrospective cohort study included 346 TBI patients on pre-injury Aspirin, Clopidogrel, or both, between the ages of 17 and 101, who were delivered to a level 1 trauma center between 1/1/2015 and 3/30/2018. Patients were divided into 2 groups: Group A did not have cerebral atrophy (n=148) and Group B had cerebral atrophy documented on computed tomography (CT) reports (n=198). Patients were excluded if they were also on anti-coagulants. Age, Injury Severity score (ISS), Revised Trauma score (RTS), Glasgow Coma score (GCS), Rotterdam CT score (RCT), Marshall CT score (MCT), incidence of intracranial hemorrhage (ICH), midline shift, platelet function and status, platelet transfusion, need for neurosurgical intervention, Intensive Care Unit length of stay (ICULOS), hospital LOS (HLOS), rate of readmission and mortality were compared.
Results:
Between Groups A and B mean values for ISS (12.9 vs 12.3), RTS (7.6 vs 7.7), GCS (14.2 vs 14.3), incidence of ICH (85.5% vs 86.9%), platelet count (215.0 vs 209.8), Platelet Function Assay (PFA)-100 epinephrine (194.7 vs 188.0), PFA-100 adenosine diphosphate (ADP) (127.0 vs 160.0), Thromboelastography Platelet Mapping (TEG-PM) % inhibition ADP (39.4% vs 39.8%), TEG-PM % inhibition of arachidonic acid (60.1% vs 56.6%), Prothrombin Time (11.5 vs 11.0 seconds), Partial Thromboplastin Time (25.7 vs 26.5 seconds), platelet transfusion (37.2% vs 44.1%), neurosurgical intervention (4.7% vs 5.1%), ICULOS (3.5 vs 2.9 days), HLOS (3.8 vs 3.8 days), and readmission rate (5.5% vs 5.1%) were similar (all p>0.07).
Group B compared to Group A had significantly lower RCT (2.7 vs 2.5; p=0.002), MCT (1.2 vs 1.0; p=0.002), midline shift (12.8% vs 3.5%; p=0.001) and mortality (14.2% vs 7.6%; p=0.04) (Fig. 1).
Conclusion:
Cerebral atrophy was associated with less severe damage and lower mortality in head trauma, despite similar injury severity, when compared to patients with no atrophy. Our findings suggest that increased intracranial volume may allow TBI patients to accommodate hematoma expansion, alleviating clinical presentation and reducing the likelihood of adverse outcomes.
