Long-term outcomes following severe traumatic brain injury in older adults: A registry-based cohort study

Abstract

RATIONALE:Older adults (aged ≥65 years) account for an increasing proportion of patients with severe traumatic brain injury (TBI), yet clinical trials and outcome studies contain relatively few of these patients. OBJECTIVES:Determine functional status six months after severe TBI in older adults, its change over two years, and outcome covariates. METHODS:Registry-based cohort study of older adults admitted to hospitals in Victoria (Australia) between 2007 and 2016 with severe TBI. Functional status was assessed with Glasgow Outcome Scale Extended (GOSE) 6, 12 and 24 months following injury. Cohort subgroups were defined by admission to an Intensive Care Unit (ICU). Features associated with functional outcome were assessed from the ICU subgroup. MEASUREMENTS AND MAIN RESULTS:There were 540 older adults hospitalised with severe TBI over the 10-year period; 428 (79%) patients died in hospital, and 456 (84%) had died six months after injury. There were 277 patients not admitted to ICU; at 6-months 268 (97%) had died, 8 (3%) were dependent (GOSE 2-4), and 1 (0.4%) functionally independent (GOSE 5-8). There were 263 patients admitted to an ICU; at 6-months 188 (73%) had died, 39 (15%) were dependent, and 32 (12%) were functionally independent; proportions that did not change over longer follow-up. The only clinical features associated with lower rate of functional independence were Injury Severity Score ≥25 (adjusted odds ratio, 0.24 [95% CI, 0.09-0.67], P=0.007) and older age groups (P=0.017). CONCLUSIONS:Severe TBI in older adults is a condition of very high mortality, and few recover to functional independence.