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

Joanna Wycech Knight; Alexander A Fokin; Nicholas Menzione; Sarah R Rabinowitz; Sari A Viitaniemi; Ivan Puente

doi:10.1080/02699052.2024.2337904

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

Brain Inj. 2024 Apr 3:1-9. doi: 10.1080/02699052.2024.2337904. Online ahead of print.

Authors

Joanna Wycech Knight^{1

2}, Alexander A Fokin^{1

3}, Nicholas Menzione¹, Sarah R Rabinowitz^{1

3}, Sari A Viitaniemi¹, Ivan Puente^{1

2

3

4}

Affiliations

¹ Delray Medical Center, Division of Trauma and Critical Care Services, Delray Beach, Florida, USA.
² Broward Health Medical Center, Division of Trauma and Critical Care Services, Fort Lauderdale, Florida, USA.
³ Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, Boca Raton, Florida, USA.
⁴ Herbert Wertheim College of Medicine, Department of Surgery, Florida International University, Miami, Florida, USA.

PMID: 38568043
DOI: 10.1080/02699052.2024.2337904

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; anticoagulation/antiplatelet reversal therapy; geriatric trauma patients; repeat head computed tomography; traumatic brain injury.