The effect of age on blunt traumatic brain-injured patients

An increasing number of super geriatric (age older than 80 years) patients are being hospitalized with traumatic brain injury (TBI). Although geriatric (age older than 65 years) patients have been reported to have a worse functional outcome compared with younger patients who present with the same or less severe degree of TBI; the mortality for the super geriatric (age older than 80 years) remains to be determined. Knowledge of their hospital mortality may help improve clinical decision-making protocols and resource use. A retrospective chart review of patients who sustained TBI after blunt trauma was performed over a 3-year period (June 2005 to June 2008) at a Level II trauma center. Mortality was calculated for various age groupings and data analyzed using analysis of variance test and chi2 test. We hypothesized that mortality would increase significantly with increasing age from the geriatric to the super geriatric group. A total of 2369 patients were evaluated with 744 pediatric patients in Group I (age younger than 17 years), 1297 adult patients in Group II (age 17-64 years), 185 geriatric patients in Group III (age 65-80 years), and 143 super geriatric patients in Group IV (age older than 80 years). The respective mortalities for each group were as follows: Group I (6%), Group II (9%), Group III (21%), and Group IV (6%). There was no significant difference in the Injury Severity Score for the four groups. In comparing Group III with Groups I and II, we found a significant increase in mortality with incresing age as reported in the literature (21 vs. 6%, P = 0.01 and 21 vs. 9%, P = 0.04). However, in comparing Group IV with the other three groups, there was no significant difference in mortality. There was a trend toward decrease in mortality from age Group III to IV (21 vs. 6%, P = 0.09), which is of unclear etiology and warrants further study. In patients with blunt TBI, there is no significant difference in mortality between the super geriatric age group (age older than 80 years) and the younger pediatric, adult, and geriatric age groups. Resource use therefore should not be limited to patients older than 80 years with TBI.