Introduction: Age-related differences may complicate the road to recovery following traumatic brain injury (TBI), leading to disparate recovery profiles across subpopulations.
Methods: We utilize the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot study to characterize young-adults (18-40), middle-aged (41-64) and elderly (65-years) following acute TBI. Multivariable multinomial regression was performed for patients completing 3-month Glasgow Outcome Scale Extended (GOSE), a measure of global functional outcome, to determine predictors of severe disability/death (GOSE 1-4), moderate disability (5-6) and good recovery (7-8). Odds ratios (OR) and 95% confidence intervals are reported.
Results: In 422 patients, (young-adult=46.0%, middle-aged=38.6%, elderly=15.4%), falls predominated middle-aged and elderly injuries (50.3%/69.2%-vs.-36.6%; p<0.001). The elderly showed decreased propensity for loss of consciousness (LOC; 36.9%-vs.-54.0%/56.7%; p=0.003) and post-traumatic amnesia (PTA; 30.7%-vs.-55.7%/41.1%; p=0.008), and lower incidence of prior TBI (23.1%-vs.-46.4%/54.6%; p<0.001). Age associated with intracranial CT pathology (38.1%, 45.4%, 61.5%, p<0.001). Elderly patients were more likely to admit to ICU (47.7%-vs.-38.1%/32.5%; p<0.001) and less likely to be discharged home (16.9%-vs.-35.1%/25.2%; p=0.001).
On multivariable regression, middle-age (OR=4.86 [2.52-9.37]), intracranial pathology (OR=2.51 [1.19-5.29], and psychiatric history (OR=2.27 [1.27-4.12]) predicted moderate disability over good recovery. Middle-age (OR=5.04 [1.61-15.73]) and elderly (OR=5.38 [1.10,26.27]), moderate/severe TBI (OR=13.38 [3.77-47.48]), polytrauma (OR=4.07 [1.49-11.16]) and history of endocrine (OR=5.84 [2.09-16.31]) or ear/nose/throat (OR=3.89 [1.25-12.09]) illnesses predicted severe disability/death over good recovery.
Conclusions: Elderly patients demonstrate lower rates of prior TBI, LOC and PTA, and higher rates of CT pathology and ICU admissions following TBI. At 3-months postinjury, middle-aged and elderly patients experience elevated risk for severe disability and/or death compared to young-adults.
Patient Care: Traumatic brain injury care is not a one-size-fits-all approach. Evidence-based guidelines applicable across the spectrum of TBI remain elusive. Age is one of the foremost critical physiologic and biopsychosocial factors for injury risk, critical care considerations, and prognosticating recovery. Improved understanding of age-specific characteristics at presentation will assist clinicians in triaging patients to applicable treatments as well as devising strategies for counseling, and identifying patients most in need of heightened surveillance as they re-enter the community, in order to optimize individual recovery, and reduce long-term burden to public health.
Learning Objectives: 1) Describe the impact of age on clinical and injury history following traumatic brain injury. 2) Discuss the differential recovery profiles of young adults, the middle-aged, and elderly patients following traumatic brain injury. 3) Identify age-specific considerations for risk stratification and prognosis following traumatic brain injury.