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. 2020 Oct 17;20(1):376.
doi: 10.1186/s12883-020-01943-6.

Traumatic brain injury-the effects of patient age on treatment intensity and mortality

Ola Skaansar  1 , Cathrine Tverdal  2   3 , Pål Andre Rønning  3 , Karoline Skogen  4 , Tor Brommeland  3 , Olav Røise  2   5 , Mads Aarhus  3 , Nada Andelic  6   7 , Eirik Helseth  2   3
Affiliations

Traumatic brain injury-the effects of patient age on treatment intensity and mortality

Ola Skaansar et al. BMC Neurol. .

Abstract

Background: Ageing is associated with worse treatment outcome after traumatic brain injury (TBI). This association may lead to a self-fulfilling prophecy that affects treatment efficacy. The aim of the current study was to evaluate the role of treatment bias in patient outcomes by studying the intensity of diagnostic procedures, treatment, and overall 30-day mortality in different age groups of patients with TBI.

Methods: Included in this study was consecutively admitted patients with TBI, aged ≥ 15 years, with a cerebral CT showing intracranial signs of trauma, during the time-period between 2015-2018. Data were extracted from our prospective quality control registry for admitted TBI patients. As a measure of management intensity in different age groups, we made a composite score, where placement of intracranial pressure monitor, ventilator treatment, and evacuation of intracranial mass lesion each gave one point. Uni- and multivariate survival analyses were performed using logistic multinomial regression.

Results: A total of 1,571 patients with TBI fulfilled the inclusion criteria. The median age was 58 years (range 15-98), 70% were men, and 39% were ≥ 65 years. Head injury severity was mild in 706 patients (45%), moderate in 437 (28%), and severe in 428 (27%). Increasing age was associated with less management intensity, as measured using the composite score, irrespective of head injury severity. Multivariate analyses showed that the following parameters had a significant association with an increased risk of death within 30 days of trauma: increasing age, severe comorbidities, severe TBI, Rotterdam CT-score ≥ 3, and low management intensity.

Conclusion: The present study indicates that the management intensity of hospitalised patients with TBI decreased with advanced age and that low management intensity was associated with an increased risk of 30-day mortality. This suggests that the high mortality among elderly TBI patients may have an element of treatment bias and could in the future be limited with a more aggressive management regime.

Keywords: Age; Management intensity; Mortality; Neurosurgery; Traumatic brain injury; Treatment.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Injury mechanism in different age groups
Fig. 2
Fig. 2
The effect of age on management intensity (= composite score) of admitted TBI patients. a The resulting density of management intensity versus age as a continuous variable. b The modelled probabilities of the different treatment intensities. Both graphs demonstrate that increasing age is associated with less management intensity irrespective of head injury severity
Fig. 3
Fig. 3
Kaplan Meyer plot of overall survival after TBI. The plot is showing poorer survival rate with increasing age of the patient
See this image and copyright information in PMC

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