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

Abstract

ABSTRACT Objective To compare outcomes between geriatric andnon-geriatric patients with traumatic brain injury (TBI) transferred to traumacenter and effects of anticoagulants/antiplatelets (AC/AP) and reversaltherapy. Methods A retrospective review of 1,118 patients with TBI transferred from acute care facilities tolevel 1 trauma center compared in groups: geriatric versus non-geriatric,geriatric with AC/AP therapy versus without, and geriatric AC/AP with AC/APreversal therapy versus without. Results Patients with TBI constituted 54.4% oftrauma transfers. Mean transfer time was 3.9 h. Propensity matched byInjury Severity Score and Abbreviated Injury Score (AIS) head geriatriccompared to non-geriatric patients had more AC/AP use (53.9% vs 8.8%), repeathead 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 onAC/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% vs57.1%), all p < 0.001. Conclusion TBI constituted half of trauma transfers and10% required surgery. Based on higher ICU admissions, mortality, and prevalenceof AC/AP therapy requiring reversal, geriatric patients with TBI onanticoagulants/antiplatelets should be considered for direct trauma centeradmission.