Comparing the outcomes of isolated, serious traumatic brain injury in older adults managed at major trauma centres and neurosurgical services: A registry-based cohort study. Issue 9 (September 2019)

• Record Type: Journal Article
• Authors: Dunn, Matthew S.; Beck, Ben; Simpson, Pam M.; Cameron, Peter A.; Kennedy, Marcus; Maiden, Matthew; Judson, Rodney; Gabbe, Belinda J.
• Is Part Of: Injury. Volume 50:Issue 9(2019)
• Page Start: 1534
• Page End: 1539
• Publication Date: 2019-09
• Subjects: Traumatic brain injury -- TBI -- Older adult -- Trauma systems -- Functional outcome; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.06.012
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: The incidence of older adult traumatic brain injury is increasing in both high and middle-to-low income countries. For older adults with isolated, serious traumatic brain injury, in-hospital mortality is comparable at major trauma and neurosurgical services. For older adults with isolated, serious traumatic brain injury, functional outcome is comparable at major trauma and neurosurgical services. Neurosurgical services, not designated as a major trauma centre, can safely manage older adults with isolated, serious traumatic brain injury. Abstract: Background: The incidence of older adult traumatic brain injury (TBI) is increasing in both high and middle to low-income countries. It is unknown whether older adults with isolated, serious TBI can be safely managed outside of major trauma centres. This registry based cohort study aimed to compare mortality and functional outcomes of older adults with isolated, serious TBI who were managed at specialised Major Trauma Services (MTS) and Metropolitan Neurosurgical Services (MNS). Method: Older adults (65 years and over) who sustained an isolated, serious TBI following a low fall (from standing or ≤ 1 m) were extracted from the Victorian State Trauma Registry from 2007 to 2016. Multivariable models were fitted to assess the association between hospital designation (MTS vs. MNS) and the two outcomes of interest: in-hospital mortality and functional outcome, adjusting for potential confounders. Functional outcomes were measured using the Glasgow Outcome Scale Extended at six months post-injury. Results: From 2007–2016, there were 1904 older adults who sustained an isolated, serious TBI from a low fall who received definitive care at an MTS (n = 1124) or an MNS (n = 780). After adjusting for confounders, there was no mortality benefit for patients managed at an MTS over an MNS (OR = 0.84; 95% CI: 0.65, 1.08; P = 0.17) or improvement in functional outcome six months post-injury (OR = 1.13; 95% CI: 0.94, 1.36; P = 0.21). Conclusion: For older adults with isolated, serious TBI following a low fall, there was no difference in mortality or functional outcome based on definitive management at an MTS or an MNS. This confirms that MNS without the added designation of a major trauma centre are a suitable destination for the management of isolated, serious TBI in older adults.