Article
Higher age is a major driver of in-hospital adverse events independent of comorbid diseases among patients with mild traumatic brain injury
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Authors
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Barbara Schmidt
- Universitätsspital Zürich, Klinik für Unfallchirurgie, Zürich, Switzerland
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Rudolf Moos
- Universitätsspital Zürich, Medizincontrolling & Statistik , Zürich, Switzerland
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Otto Meyer
- Universitätsspital Zürich, Klinik für Geriatrie, Zürich, Switzerland
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Guido Wanner
- Universitätsspital Zürich, Klinik für Unfallchirurgie, Zürich, Switzerland
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Hans-Peter Simmen
- Universitätsspital Zürich, Klinik für Unfallchirurgie, Zürich, Switzerland
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Dilek Könü-Leblebicioglu
- Universitätsspital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland
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Heike A. Bischoff-Ferrari
- Universitätsspital Zürich, Klinik für Geriatrie, Zürich, Switzerland
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Valentin Neuhaus
- Universitätsspital Zürich, Klinik für Unfallchirurgie, Zürich, Switzerland
| Published: | October 10, 2016 |
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Outline
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Objectives: Mild traumatic brain injury (mTBI) is the most frequent traumatic brain injury, also in the growing number of senior patients treated in trauma units. However, data of in-hospital adverse events and their risk factors is limited among senior patients. The goal of this study was to investigate if and to what extend age, independent of comorbid diseases, is a risk factor for negative in-hospital outcome with mTBI.
Methods: In a retrospective cohort study we identified all consecutive patients treated for isolated mTBI in our level-1 trauma center between 2008 and 2014. Additional inclusion criteria were age 18 and older plus a computer tomography of the head (cCT) upon admission to exclude patients with major brain injury based on cCT documented intracranial hemorrhage or fractures of the skull. We used logistic regression analyses to assess the odds of any adverse event by age group (<65, 65 to 75, 76 to 85, and 85+), adjusting for gender and chronic diseases.
Results and Conclusion: We identified 1589 patients who met our inclusion criteria for mTBI. Mean age of mTBI patients was 45 years (SD +/- 21), 22% were age 65+, and 4.9% were age 85+. The prevalence of any adverse event during in-hospital care among mTBI patients was 3.2% overall, 1.8% among those younger than age 65, 2.1% among those age 65 to 75, 8% among those age 75 to 85, and 19% among those age 85+.
Compared to patients with mTBI younger than 65 years of age and independent of the other covariates, the odds of any adverse event was similar in patients aged 65 to 75, but increased among senior patients 4.4-fold for age 75 to 85 (OR 4.4, 95% CI 2.0 - 9.7, p<0.001), and 12-fold for age 85+ (OR 12.0, 95% CI 6.0 - 26, p<0.001).
Additionally, diabetes mellitus (OR 3.4, 95% CI 1.4 - 8.2, p=0.007), and psychiatric diseases (OR 2.8, 95% CI 1.6 - 5.2, p=0.001) increased the odds of any adverse events independent of age and all other covariates.
Based on our retrospective cohort of consecutive patents with isolated mTBI, the overall prevalence of any adverse event during in-hospital care was relatively low with 3.2%. Notably, however, the odds of sustaining an adverse event increased exponentially after age 75 independent of gender and any comorbid disease. Our data support international efforts to manage senior patients in interdisciplinary Geriatric Trauma Units.
