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

Mira Ghneim; Karen Brasel; Roumen Vesselinov; Jennifer Albrecht; Anna Liveris; Jill Watras; Christopher Michetti; James Haan; Kelly Lightwine; Robert Winfield; Sasha Adams; Jeanette Podbielski; Scott Armen; J. Christopher Zacko; Fady Nasrallah; Kathryn Schaffer; Julie Dunn; Brittany Smoot; Thomas Schroeppel; Zachery Stillman; Zara Cooper; Deborah Stein; Charles Adams; Stephanie Lueckelm; Jason Murry; Cindy Hsu; Umer Bhatti; Matthew Lissauer; Marc LaFonte; Kaveh Najafi; Karen Lewandowski; Kaushik Mukherjee; Kristelle Imperio-Lagabon; Niels Martin; Kathleen Hirsch; Cherisse Berry; Derek Freitas; Daniel Cullinane; Roshini Ramwani; Michael Truitt; Chris Pearcy; Habiba Hashimi; Krista Kaups; Jeffry Claridge; Husayn Ladhani; Jennifer Hartwell; Jessica Ballou; Martin Croce; Stephanie Markle; Sally Osserwaarde; Joseph Posluszny; Benjamin Stocker; Tjasa Hranjec; Rachele Solomon; Lucy Martinek; Alok Gupta; Daniel J. Grabo; Uzer Khan; Danielle Tatum; Tomas Jacome; Jonathan Gates; Alisha Jawani; Allison Berndtson; Terry Curry; Miklosh Bala; Linda Dultz; Natasha Houshmand; Paola Pieri; Martin Zielinski; Joy Hughes; Ajai Malhotra; Tim Lee; Patrizio Petrone; D'andrea Joseph; Gary Marshall; Matthew Carrick; Abhijit Pathak; Andrea Van Zandt; Nina Glass; David Livingston; Shea Gregg; Travis Webb; Byron Drumheller; Rosemary Kozar; Robert Barraco; Bellal Joseph; Additional Study Group Members of The American Association for the Surgery of Trauma Geri-TBI Study

doi:10.1016/j.jamda.2022.01.085

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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

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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

Mira Ghneim, Karen Brasel, Roumen Vesselinov, Jennifer Albrecht, Anna Liveris, Jill Watras, Christopher Michetti, James Haan, Kelly Lightwine, Robert Winfield, …

Journal of the American Medical Directors Association, Vol.23(4), pp.568-575.e1

04/2022

DOI: https://doi.org/10.1016/j.jamda.2022.01.085

PMID: 35283084

Abstract

Geriatric

moderate/severe TBI

mortality

older adults

palliative interventions

traumatic brain injury

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. Prospective observational study of geriatric patients with TBI enrolled across 45 trauma centers. 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. 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. 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. 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.

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Title: 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
Creators: Mira Ghneim - University of Maryland Medical Center
Karen Brasel - University of Tennessee Health Science Center
Roumen Vesselinov - University of Maryland, Baltimore
Jennifer Albrecht - University of Maryland, Baltimore
Anna Liveris - University of Maryland Medical Center
Jill Watras - Inova Fairfax Hospital
Christopher Michetti - Inova Fairfax Hospital
James Haan - Ascension Via Christi
Kelly Lightwine - Ascension Via Christi Hospital
Robert Winfield - University of Kansas Medical Center
Sasha Adams - The University of Texas Health Science Center at Houston
Jeanette Podbielski - The University of Texas Health Science Center at Houston
Scott Armen - Penn State Milton S. Hershey Medical Center
J. Christopher Zacko - Penn State Milton S. Hershey Medical Center
Fady Nasrallah - Scripps Memorial Hospital
Kathryn Schaffer - Scripps Memorial Hospital
Julie Dunn - Department of Surgery, Medical Center of the Rockies, Loveland, CO, USA
Brittany Smoot - Department of Surgery, Medical Center of the Rockies, Loveland, CO, USA
Thomas Schroeppel - University of Colorado Denver
Zachery Stillman - University of Colorado Hospital
Zara Cooper - Brigham and Women's Hospital
Deborah Stein - University of Maryland, Baltimore
Charles Adams - The University of Texas Health Science Center at Houston
Stephanie Lueckelm - Rhode Island Hospital
Jason Murry - The University of Texas Health Science Center at Tyler
Cindy Hsu - University of Michigan
Umer Bhatti - University of Michigan
Matthew Lissauer - Department of Surgery, Rutgers-Robert Wood Johnson Medical School, Clinical Academic Building, New Brunswick, NJ, USA
Marc LaFonte - Department of Surgery, Rutgers-Robert Wood Johnson Medical School, Clinical Academic Building, New Brunswick, NJ, USA
Kaveh Najafi - Department of Surgery, Honor Health Scottdale Osborn Medical Center, Scottsdale, AZ, USA
Karen Lewandowski - University of Tennessee Health Science Center
Kaushik Mukherjee - Loma Linda University Medical Center
Kristelle Imperio-Lagabon - Loma Linda University Medical Center
Niels Martin - University of Pennsylvania
Kathleen Hirsch - University of Pennsylvania
Cherisse Berry - Department of Surgery, Division of Acute Care Surgery, New York University/Bellevue Hospital Center, New York, NY, USA
Derek Freitas - Department of Surgery, Division of Acute Care Surgery, New York University/Bellevue Hospital Center, New York, NY, USA
Daniel Cullinane - Marshfield Clinic
Roshini Ramwani - Department of Surgery, Marshfield Clinic, Marshfield, WI, USA
Michael Truitt - Methodist Dallas Medical Center
Chris Pearcy - Penn State Milton S. Hershey Medical Center
Habiba Hashimi - University of California, San Francisco
Krista Kaups - University of California, San Francisco
Jeffry Claridge - MetroHealth Medical Center
Husayn Ladhani - MetroHealth Medical Center
Jennifer Hartwell - University of Maryland, Baltimore
Jessica Ballou - University of Portland
Martin Croce - University of Tennessee Health Science Center
Stephanie Markle - Ascension
Sally Osserwaarde - Ascension
Joseph Posluszny - Department of Surgery, Division of Trauma and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Benjamin Stocker - Department of Surgery, Division of Trauma and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Tjasa Hranjec - Department of Surgery, Division of Trauma and Acute Care Surgery, Memorial Regional Hospital, Hollywood, FL, USA
Rachele Solomon - Department of Surgery, Division of Trauma and Acute Care Surgery, Memorial Regional Hospital, Hollywood, FL, USA
Lucy Martinek - Beth Israel Deaconess Medical Center
Alok Gupta - Beth Israel Deaconess Medical Center
Daniel J. Grabo - West Virginia University
Uzer Khan - West Virginia University
Danielle Tatum - Our Lady of the Lake Regional Medical Center
Tomas Jacome - Our Lady of the Lake Regional Medical Center
Jonathan Gates - Hartford Hospital
Alisha Jawani - Hartford Hospital
Allison Berndtson - University of California, San Diego
Terry Curry - University of California, San Diego
Miklosh Bala - Department of Surgery, Division of Trauma and Acute Care Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Linda Dultz - The University of Texas Southwestern Medical Center
Natasha Houshmand - The University of Texas Southwestern Medical Center
Paola Pieri - Phoenix
Martin Zielinski - Mayo Clinic
Joy Hughes - Mayo Clinic
Jennifer Hartwell - University of Maryland, Baltimore
Ajai Malhotra - University of Vermont
Tim Lee - Inova Fairfax Hospital
Patrizio Petrone - Department of Surgery, New York University Winthrop Hospital, Mineola, NY, USA
D'andrea Joseph - Department of Surgery, New York University Winthrop Hospital, Mineola, NY, USA
Gary Marshall - Department of Surgery, Medical Center Plano, Plano, TX, USA
Matthew Carrick - Department of Surgery, Medical Center Plano, Plano, TX, USA
Abhijit Pathak - Temple University Hospital
Andrea Van Zandt - Temple University Hospital
Nina Glass - University Hospital, Newark
David Livingston - University Hospital, Newark
Shea Gregg - Bridgeport Hospital
Travis Webb - Medical College of Wisconsin
Byron Drumheller - University of Maryland Medical Center
Rosemary Kozar - University of Maryland Medical Center
Robert Barraco - University of Kansas Medical Center
Bellal Joseph - University of Arizona
Additional Study Group Members of The American Association for the Surgery of Trauma Geri-TBI Study
Publication Details: Journal of the American Medical Directors Association, Vol.23(4), pp.568-575.e1
Publisher: Elsevier Inc
Grant note: American Sleep Medicine Foundation (https://doi.org/10.13039/100002600) Merck (https://doi.org/10.13039/100004334) ResMed
Identifiers: 991006228465502656
Academic Unit: Surgery
Language: English
Resource Type: Journal article

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

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