Traumatic Brain Injury in Older Adults: Characteristics, Outcomes, and Considerations. Results From the American Association for the Surgery of Trauma Geriatric Traumatic Brain Injury (GERI-TBI) Multicenter Trial.

Autor:	Ghneim M; Division of Trauma, Critical Care and Acute Care Surgery, R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, Baltimore, MD, USA. Electronic address: mira.ghneim@som.umaryland.edu., Brasel K; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA., Vesselinov R; Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA., Albrecht J; Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA., Liveris A; Division of Trauma, Critical Care and Acute Care Surgery, R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, Baltimore, MD, USA., Watras J; Department of Trauma Services, Inova Fairfax Medical Campus, Falls Church, VA, USA., Michetti C; Department of Trauma Services, Inova Fairfax Medical Campus, Falls Church, VA, USA., Haan J; Department of Surgery, Ascension Via Christi Hospital, Wichita, KS, USA., Lightwine K; Department of Surgery, Ascension Via Christi Hospital, Wichita, KS, USA., Winfield R; Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, University of Kansas Medical Center, Kansas City, KS, USA., Adams S; Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA., Podbielski J; Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA., Armen S; Departments of Surgery and Neurosurgery, Penn State Health System, Hershey, PA, USA., Zacko JC; Departments of Surgery and Neurosurgery, Penn State Health System, Hershey, PA, USA., Nasrallah F; Department of Surgery, Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA., Schaffer K; Department of Surgery, Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA., Dunn J; Department of Surgery, Medical Center of the Rockies, Loveland, CO, USA., Smoot B; Department of Surgery, Medical Center of the Rockies, Loveland, CO, USA., Schroeppel T; Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, UC Health Memorial Hospital, Colorado Springs, CO, USA., Stillman Z; Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, UC Health Memorial Hospital, Colorado Springs, CO, USA., Cooper Z; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA., Stein D; Division of Trauma, Critical Care and Acute Care Surgery, R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, Baltimore, MD, USA.
Jazyk:	angličtina
Zdroj:	Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2022 Apr; Vol. 23 (4), pp. 568-575.e1. Date of Electronic Publication: 2022 Mar 10.
DOI:	10.1016/j.jamda.2022.01.085
Abstrakt:	Objectives: Describe the epidemiology of a large cohort of older adults with isolated traumatic brain injury (TBI) and identify predictors of mortality, palliative interventions, and discharge to preinjury residence in those presenting with moderate/severe TBI. Design: Prospective observational study of geriatric patients with TBI enrolled across 45 trauma centers. Setting and Participants: Inclusion criteria were age ≥40 years, and computed tomography (CT)-verified TBI. Exclusion criteria were any other body region abbreviated injury scale score >2 and presentation at enrolling center >24 hours after injury. Methods: The analysis was restricted to individuals aged ≥65 and stratified into 3 age groups: young-old (65-74), middle-old (75-84), and oldest-old (≥85). Demographic, clinical, and injury data were collected. Predictors of mortality, palliative interventions, and discharge to preinjury residence in the moderate/severe TBI group were identified using Classification and Regression Tree and Generalized Linear Mixed Models. Results: Of the 3081 subjects enrolled in the study, 2028 were ≥65 years old. Overall, 339 (16.7%) presented with a moderate/severe TBI and experienced a 64% mortality rate. A Glasgow Coma Scale (GCS) score <9 was the main predictor of mortality, CT worsening (odds ratio [OR] = 1.7, P < .04), cerebral edema (OR = 2.4, P < .04), GCS <9, and age ≥75 (OR = 2.1, P = .007) were predictors for palliative interventions, and an injury severity score ≤24 (OR = 0.087, P = .002) was associated with increased likelihood of discharge to preinjury residence in the moderate/severe TBI group. Conclusion and Implications: In this prospective study of a large cohort of older adults with isolated TBI, comparisons across the older age groups with moderate/severe TBI revealed that survival and favorable discharge disposition were influenced more by severity of injury rather than age itself. Indicating that chronological age alone maybe insufficient to accurately predict outcomes, and increased representation of older adults in TBI research to develop better diagnostic and prognostic tools is warranted. (Copyright © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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