75.15 Age Predicts Discharge Disposition but Not Adjusted Mortality After Nonoperative Management of TBI

Posted on January 18, 2016

Q. Dang1,2, S. Moradian1,2, J. Catino1, L. Zucker1, I. Puente1, F. Habib1, M. Bukur1 1Delray Medical Center,Department Of Trauma And Surgical Critical Care,Delray Beach, FL, USA 2Larkin Community Hospital,Department Of Surgery,Miami, FL, USA

Introduction: Traumatic Brain Injury (TBI) continues to be a leading cause of death and disability particularly in the elderly population. Age is generally considered to be a risk factor for adverse outcomes after TBI. We sought to examine the impact of age on outcomes in TBI patients who do not require neurosurgical operative intervention.

Methods: This was a retrospective review of all patients with survivable head injuries undergoing nonoperative management at a Level I trauma center from 2008-2013. Patients were stratified by age into young and elderly groups using the age of 40 as a reference group based upon the current Brain Trauma Foundation guidelines. Logistic regression was used to adjust for baseline differences in demographic and injury variables to determine the effect of age on outcomes. The primary outcomes were in-hospital mortality, worsening discharge GCS, and discharge disposition.

Results: 1,869 patients met inclusion criteria with 77% of patients being older than 40 years. Elderly patients were more likely to be victims of falls and presented with a higher GCS despite having a higher Head AIS. Immediate need for non-intracranial operative intervention was greater in younger patients. After adjusting for differences in characteristics, there was no significant difference in overall mortality (Elderly 3.6% vs. young 5%, p=0.209) or worsening discharge GCS (14% vs. 11%, p=0.926). However, younger patients were more likely to be discharged to a rehabilitation facility or home (91% vs. 70%, AOR=2.4, p=0.001). Stratification of mortality by decade revealed similar results, with adjusted mortality being lower in the sixth and ninth decades of life (Figure).

Conclusion: Survival of patients sustaining TBI not requiring neurosurgical operative intervention may not be age dependent. However, age is associated with a less favorable discharge disposition that is independent of discharge GCS.

17.06 Not as Futile as We Think: Age Adjusted Outcomes After Craniotomy for T.B.I. in the Elderly

Posted on January 18, 2016

S. R. Moradian1,2, Q. Dang1,2, I. Puente2, J. Catino2, F. Habib2, L. Zucker2, M. Bukur2 1Larkin Community Hospital,General Surgery,Miami, FL, USA 2Delray Medical Center,Trauma Surgery,Delray Beach, FL, USA

Introduction: Traumatic Brain Injury (TBI) continues to be a leading cause of death and disability particularly in the elderly population. Age is considered a risk factor for adverse outcomes after TBI however the impact of age on outcomes after surgical therapy for TBI is less well understood. We hypothesized that age alone would not be a risk factor for unfavorable outcomes after surgical treatment for TBI.

Methods: This was a retrospective review of all survivable head injuries undergoing craniotomy at a Level I trauma center from 2008-2013. Patients were stratified by age into young and elderly groups using the age of 40 as a reference group based upon current Brain Trauma Foundation guidelines. Logistic regression was used to adjust for baseline differences in demographic and injury variables to determine the effect of age on outcomes. The primary outcomes were in-hospital mortality, worsening discharge GCS, and discharge disposition.

Results: 265 patients met inclusion criteria. Overall rate of craniotomy for the 6 year period was 12.4% and was not significantly different between groups. Elderly patients were more likely to be victims of falls and present with a higher GCS despite having a higher Head AIS. Immediate need for operative intervention was similar between groups. After adjusting for differences in characteristics, there was no significant difference in overall mortality (8%vs 15%, p=0.383), worsening discharge GCS (21%, p=0.187).or rehabilitation placement (32.9% vs. 23.15, p=0.740). Stratification of mortality by decade revealed similar results.

Conclusion: Favorable outcomes after craniotomy for TBI appear to be obtainable in the elderly population. Using age alone as criterion for surgical intervention after TBI should be avoided.