Withdrawal of life support following interfacility transfer in older adults with traumatic brain injury

Older adults with traumatic brain injury are often transferred to higher-level trauma centers. This study aimed to evaluate outcomes of older patients transferred to trauma centers for the management of traumatic brain injury.

This is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database from 2017 to 2019. Patients (aged ≥65 years) with isolated traumatic brain injury treated in level 1/2 trauma centers were included. Injury characteristics, neurosurgical management, and outcomes were compared between patients transferred from another hospital and those who were directly transported to trauma centers. The primary outcome was withdrawal of life support. In transferred patients, clinical factors associated with early (≤2 days after admission) and overall withdrawal of life support were identified using lasso regression and logistic regression models.

A total of 105,491 patients met the study criteria, of whom 48,606 (46.1%) were transferred. The rates of early and overall withdrawal of life support in transferred patients were comparable to those in nontransferred patients (3.4% vs 4.8% and 7.6% vs 10.0%, standardized mean difference: 0.086 and 0.073). In transferred patients with head Abbreviated Injury Scale 5, the rates of early and overall withdrawal of life support were 11.9% and 23.1%, respectively. The regression model demonstrated areas under the receiver operating characteristic curve of 0.942 for early withdrawal of life support and 0.908 for overall withdrawal of life support in transferred patients.

Our results suggest that transferred older adults with traumatic brain injury, particularly those with severe traumatic brain injury, often undergo withdrawal of life support at higher-level trauma centers.