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. 2025 Jun 2.
doi: 10.1007/s43678-025-00941-2. Online ahead of print.

The increased mortality of older patients with moderate traumatic brain injury

Chartelin Jean Isaac  1 , Axel Benhamed  1   2   3 , Valérie Boucher  1 , Samuel Lauzon  1   2 , Pierre-Gilles Blanchard  1   2 , Christian Malo  1   2 , Francis Bernard  4   5 , Jean-Marc Chauny  4   5 , Mélanie Bérubé  1   2 , Eric Mercier  1   2   6 , Amaury Gossiome  1   2   3 , Myreille D'Astous  2   7 , Marcel Émond  8   9   10   11
Affiliations

The increased mortality of older patients with moderate traumatic brain injury

Chartelin Jean Isaac et al. CJEM. .

Abstract
in English, French

Purpose: Higher mortality has been reported in older patients with moderate traumatic brain Injuries (TBI) compared to younger patients. To identify the risk factors associated with in-hospital mortality, complications and extended length of stay in moderate TBI patients.

Methods: DESIGN: a multicentre observational cohort study using the Quebec Trauma Registry.

Population: Hospitalized patients aged ≥ 16 with a moderate TBI (a head injury with an Abbreviated Injury Scale (AIS) ≥ 3, and a GCS score of 9-12).

Outcomes: In-hospital mortality, complications and prolonged length of stay.

Analyses: Multivariable logistic regression.

Results: We included 1005 patients, 38.1% of whom were aged ≥ 65. The in-hospital mortality rate was 20.1%. Male sex (OR = 1.6 [95% CI:1.02-2.6], age (≥ 85 years old VS < 65 years) (OR = 18.7 [95% CI: 9.2-38.1]), ≥ 2 comorbidities (OR = 2.3 [95% CI: 1.3-4.0]), Injury Severity Score (OR = 1.04 [95% CI: 1.01-1.1]), presence of intraparenchymal hematoma (OR = 3.5 [95% CI: 2.2-5.5]) or other CT scan findings (cerebral edema, pneumocephalus, subpial hemorrhage, and pituitary injury) (OR = 1.9 [95% CI: 1.2-3.1]) were associated with increased odds of mortality. Male sex (OR = 1.8 [95% CI: 1.2-2.6]), age (65-74: OR = 1.7 [95% CI: 1.1-2.8] & 75-84: OR = 1.6 [95% CI: 1.03-2.6]), ≥ 2 comorbidities (OR = 2.9 [95% CI: 1.8-4.7]), thoraco-abdominal concomitant injury (OR = 2.0 [95% CI: 1.01-3.8]), and subarachnoid hemorrhage (OR = 7.6 [95% CI:1.5-38.5]) were associated with increased odds of complications. The number of comorbidities (≥ 2 OR = 1.7 [95% CI: 1.1-2.7]), spine injury (OR = 2.4 [95% CI: 1.4-4.1]), and delirium (OR = 3.1 [95% CI:1.8-5.2]) were associated with an increased odd of extended length of stay.

Conclusions: This study identified risk factors of in-hospital mortality, complications and extended length of stay, most of which are quickly available in the Emergency Department (ED). These factors could help clinicians identify moderate TBI patients at high risk of in-hospital mortality and guide shared decision-making regarding goals of care.

RÉSUMÉ: BUT: Une mortalité plus élevée a été rapportée chez les patients âgés présentant des lésions cérébrales traumatiques (TBI) modérées par rapport aux patients plus jeunes. Identifier les facteurs de risque associés à la mortalité en milieu hospitalier, aux complications et à la durée prolongée du séjour chez les patients atteints d’un TBI modéré. MéTHODES: Conception : étude de cohorte multicentrique observationnelle utilisant le Registre des traumatismes du Québec. Population : Patients hospitalisés âgés de 16 ans présentant un CT modéré (une lésion de la tête avec une échelle abrégée des blessures (SIA) 3 et un score de 9 à 12 au SCM). Résultats : mortalité en milieu hospitalier, complications et durée prolongée du séjour. Analyses : régression logistique multivariée. RéSULTATS: Nous avons inclus 1005 patients, dont 38,1 % étaient âgés de 65 ans. Le taux de mortalité en milieu hospitalier était de 20,1 %. Sexe masculin (OR=1,6 [IC à 95 % : 1,02-2,6], âge ( 85 ans VS <65 ans) (OR=18,7 [IC à 95 % : 9,2-38,1]), 2 comorbidités (OR=2,3 [IC à 95 % : 1,3-4,0]), score de gravité des blessures (OR=1,04 [IC à 95 % : 1,01-1,1]), présence d’un hématome intraparenchymal (OR=3,5 [IC à 95 % : 2,2-5,5]) ou autres résultats de tomographie (œdème cérébral, pneumocéphale, hémorragie sous-pituitaire et lésion de l’hypophyse) (OR=1,9 [IC à 95 % : 1,2-3,1]) étaient associés à une augmentation des risques de mortalité. Male sex (OR=1.8 [95%CI : 1.2-2.6]), age (65-74 : OR=1.7 [95%CI : 1.1-2.8] & 75-84 : OR=1.6 [95%CI : 1.03-2.6]), ≥2 comorbidities (OR=2.9 [95%CI : 1.8-4.7]), thoraco-abdominal concomitant injury (OR=2.0 [95%CI : 1.01-3.8]), and subarachnoid hemorrhage (OR=7.6 [95%CI:1.5-38.5]) étaient associés à une augmentation des risques de complications. Le nombre de comorbidités (2 OR=1,7 [IC95 % : 1,1-2,7]), de lésions à la colonne vertébrale (OR=2,4 [IC95 % : 1,4-4,1]) et de délire (OR=3,1 [IC95 % : 1,8-5,2]] ) était associé à une augmentation de la durée du séjour prolongé. CONCLUSIONS: Cette étude a permis d’identifier les facteurs de risque liés à la mortalité en milieu hospitalier, aux complications et à la durée prolongée du séjour, dont la plupart sont rapidement disponibles dans le service des urgences (DA). Ces facteurs pourraient aider les cliniciens à identifier les patients atteints de TBI modéré présentant un risque élevé de mortalité en milieu hospitalier et guider la prise de décisions partagées concernant les objectifs des soins.

Keywords: Mortality; Older patients; Traumatic brain injury.

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Conflict of interest statement

Declarations. Conflict of interest: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

References

    1. Toro C, Hatfield J, Temkin N, Barber J, Manley G, Ohnuma T, et al. Risk factors and neurological outcomes associated with circulatory shock after moderate-severe traumatic brain injury: a TRACK-TBI study. Neurosurgery. 2022;91(3):427–36. https://doi.org/10.1227/neu.0000000000002042 . - DOI - PubMed - PMC
    1. Forssten SP, Ahl Hulme R, Forssten MP, Ribeiro MAF Jr, Sarani B, Mohseni S. Predictors of outcomes in geriatric patients with moderate traumatic brain injury after ground level falls. Front Med (Lausanne). 2023;10:1290201. https://doi.org/10.3389/fmed.2023.1290201 . - DOI - PubMed
    1. Watanitanon A, Lyons VH, Lele AV, Krishnamoorthy V, Chaikittisilpa N, Chandee T, et al. Clinical epidemiology of adults with moderate traumatic brain injury. Crit Care Med. 2018;46(5):781–7. https://doi.org/10.1097/ccm.0000000000002991 . - DOI - PubMed - PMC
    1. Strnad M, Borovnik Lesjak V, Vujanović V, Križmarić M. Predictors of mortality in patients with isolated severe traumatic brain injury. Wien Klin Wochenschr. 2017;129(3–4):110–4. https://doi.org/10.1007/s00508-016-0974-0 . - DOI - PubMed
    1. Moore L, Turgeon AF, Lauzier F, Émond M, Berthelot S, Clément J, et al. Evolution of patient outcomes over 14 years in a mature, inclusive Canadian trauma system. World J Surg. 2015;39(6):1397–405. https://doi.org/10.1007/s00268-015-2977-9 . - DOI - PubMed

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