Are geriatric transfer patients with traumatic brain injury at risk for worse outcomes compared to non-geriatric? Propensity-matched study

ABSTRACT

Objective

To compare outcomes between geriatric and non-geriatric patients with traumatic brain injury (TBI) transferred to trauma center and effects of anticoagulants/antiplatelets (AC/AP) and reversal therapy.

Methods

A retrospective review of 1,118 patients with TBI transferred from acute care facilities to level 1 trauma center compared in groups: geriatric versus non-geriatric, geriatric with AC/AP therapy versus without, and geriatric AC/AP with AC/AP reversal therapy versus without.

Results

Patients with TBI constituted 54.4% of trauma transfers. Mean transfer time was 3.9 h. Propensity matched by Injury Severity Score and Abbreviated Injury Score (AIS) head geriatric compared to non-geriatric patients had more AC/AP use (53.9% vs 8.8%), repeat head computed tomography (93.7% vs 86.1%), intensive care unit (ICU) admissions (57.4% vs 45.7%) and mortality (9.8% vs 3.2%), all p < 0.004. Patients on AC/AP versus without had more ICU admissions (69.1% vs 51.8%, p < 0.001). Patients with AC/AP reversals compared to without reversals had more AIS head 5 (32.0% vs 13.1%), brain surgeries (17.8% vs 3.5%) and ICU admissions (84.8% vs 57.1%), all p < 0.001.

Conclusion

TBI constituted half of trauma transfers and 10% required surgery. Based on higher ICU admissions, mortality, and prevalence of AC/AP therapy requiring reversal, geriatric patients with TBI on anticoagulants/antiplatelets should be considered for direct trauma center admission.

KEYWORDS:

• Trauma transfers
• geriatric trauma patients
• traumatic brain injury
• anticoagulation/antiplatelet reversal therapy
• repeat head computed tomography

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical Standards and Informed Consent Statement

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (MetroWest IRB) granted a waiver for informed consent for this study.

Presentations

An abstract including some findings from this study was presented at the 16^th Annual Academic Surgical Congress in 2021 and 5^th World Trauma Congress in 2021.

Data availability statement

When requested, deidentified data can be made available by contacting Dr Alexander Fokin. [email protected]

CRediTAuthorContributions

JWK: methodology, investigation, software, formal analysis, writing – original draft, review and editing.

AAF: conceptualization, methodology, project administration, formal analysis, supervision, validation, writing – original draft, review and editing.

NM: investigation, formal analysis, validation, writing – original draft, review and editing.

SRR: investigation, formal analysis, writing – original draft, review and editing.

SAV: investigation, formal analysis, writing – original draft, review and editing.

IP: conceptualization, methodology, project administration, validation, supervision, writing – review and editing.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.