In-Hospital Mortality Following Traumatic Brain Injury Among Older Medicare Beneficiaries, Comparing Statin Users With Nonusers

Background: Traumatic brain injury (TBI) is a significant public health concern for older adults. Small-scale human studies have suggested pre-TBI statin use is associated with decreased in-hospital mortality following TBI, highlighting the need for large-scale translational research. Objective: To investigate the relationship between pre-TBI statin use and in-hospital mortality following TBI. Methods: A retrospective study of Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 was conducted to assess the impact of pre-TBI statin use on in-hospital mortality following TBI. Exposure of interest included atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Beneficiaries were classified as current, recent, past, and nonusers of statins prior to TBI. The outcome of interest was in-hospital mortality. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) comparing current, recent, and prior statin use to nonuse. Results: Most statin users were classified as current users (90%). Current atorvastatin (OR = 0.88; 95% = CI 0.82, 0.96), simvastatin (OR = 0.84; 95% CI = 0.79, 0.91), and rosuvastatin (OR = 0.79; 95% CI = 0.67, 0.94) use were associated with a significant decrease in the risk of in-hospital mortality following TBI. Conclusions: In addition to being the most used statins, current use of atorvastatin, rosuvastatin, and simvastatin was associated with a significant decrease in in-hospital mortality following TBI among older adults. Future research must include clinical trials to help exclude the possibility of a healthy user effect in order to better understand the impact of statin use on in-hospital mortality following TBI.

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Patterns of Statin Use in Older Medicare Beneficiaries With Traumatic Brain Injury

Journal of Pharmacy Technology ◽

10.1177/8755122517710671 ◽

2017 ◽

Vol 33 (4) ◽

pp. 156-166

Author(s):

Bilal Khokhar ◽

Linda Simoni-Wastila ◽

Julia F. Slejko ◽

Eleanor Perfetto ◽

Min Zhan ◽

...

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

National Sample ◽

Pharmacological Therapy ◽

Medicare Beneficiaries ◽

Future Studies ◽

Factors Associated ◽

The Impact ◽

Statin Use

Background: In addition to lowering lipids, statins also may be beneficial for older adults sustaining a traumatic brain injury (TBI), as statin use prior to and following trauma may decrease mortality following injury. However, despite statins’ potential to reduce mortality, there is limited research regarding statin use among older adults. Objective: To characterize and investigate factors associated with statin use among older adults with TBI. Methods: A retrospective drug utilization study was used to characterize statin use among Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 and with continuous Medicare Parts A, B, and D coverage 6 months prior and 12 months following TBI. Logistic regression was used to investigate the factors associated with statin use. The exposure of interest was statin use prior to and following TBI. Results: Of the 75 698 beneficiaries included in the study, 37 874 (~50%) of beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, while fluvastatin was the least used statin. Statin users were more likely to have cardiovascular diseases when compared to nonusers. Hyperlipidemia was a major factor associated with statin use and had the greatest impact on statin use compared to nonuse (odds ratio = 9.54; 95% confidence interval = 9.07, 10.03). Conclusions: This national sample of older adults with TBI suggests that statins are commonly used. Future studies must next examine the impact of statin use on mortality and secondary injury in order to shape pharmacological therapy guidelines following TBI.

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The impact of major depression on outcome following mild-to-moderate traumatic brain injury in older adults

Yearbook of Psychiatry and Applied Mental Health ◽

10.1016/s0084-3970(08)70567-x ◽

2007 ◽

Vol 2007 ◽

pp. 267-268

Author(s):

J.C. Ballenger

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Major Depression ◽

Moderate Traumatic Brain Injury ◽

The Impact

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The Impact of Accidental Hypothermia on Mortality in Trauma Patients Overall and Patients with Traumatic Brain Injury Specifically: A Systematic Review and Meta-Analysis

World Journal of Surgery ◽

10.1007/s00268-020-05750-5 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4106-4117

Author(s):

David Rösli ◽

Beat Schnüriger ◽

Daniel Candinas ◽

Tobias Haltmeier

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Meta Analysis ◽

Accidental Hypothermia ◽

Trauma Patients ◽

Qualitative Synthesis ◽

Pubmed Database ◽

The Impact

Abstract Background Accidental hypothermia is a known predictor for worse outcomes in trauma patients, but has not been comprehensively assessed in a meta-analysis so far. The aim of this systematic review and meta-analysis was to investigate the impact of accidental hypothermia on mortality in trauma patients overall and patients with traumatic brain injury (TBI) specifically. Methods This is a systematic review and meta-analysis using the Ovid Medline/PubMed database. Scientific articles reporting accidental hypothermia and its impact on outcomes in trauma patients were included in qualitative synthesis. Studies that compared the effect of hypothermia vs. normothermia at hospital admission on in-hospital mortality were included in two meta-analyses on (1) trauma patients overall and (2) patients with TBI specifically. Meta-analysis was performed using a Mantel–Haenszel random-effects model. Results Literature search revealed 264 articles. Of these, 14 studies published 1987–2018 were included in the qualitative synthesis. Seven studies qualified for meta-analysis on trauma patients overall and three studies for meta-analysis on patients with TBI specifically. Accidental hypothermia at admission was associated with significantly higher mortality both in trauma patients overall (OR 5.18 [95% CI 2.61–10.28]) and patients with TBI specifically (OR 2.38 [95% CI 1.53–3.69]). Conclusions In the current meta-analysis, accidental hypothermia was strongly associated with higher in-hospital mortality both in trauma patients overall and patients with TBI specifically. These findings underscore the importance of measures to avoid accidental hypothermia in the prehospital care of trauma patients.

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Early versus Late Tracheostomy: Is There an Outcome Difference?

The American Surgeon ◽

10.1177/000313481908500427 ◽

2019 ◽

Vol 85 (4) ◽

pp. 370-375 ◽

Cited By ~ 7

Author(s):

Adel Elkbuli ◽

Raed Ismail Narvel ◽

Paul J. Spano ◽

Valerie Polcz ◽

Astrid Casin ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Glasgow Coma Scale ◽

Primary Outcome ◽

Injury Severity ◽

Future Research ◽

Trauma Patients ◽

Early Tracheostomy ◽

Outcome Difference ◽

The Impact

The effect of timing in patients requiring tracheostomy varies in the literature. The purpose of this study was to evaluate the impact of early tracheostomy on outcomes in trauma patients with and without traumatic brain injury (TBI). This study is a four-year review of trauma patients undergoing tracheostomy. Patients were divided into two groups based on TBI/non-TBI. Each group was divided into three subgroups based on tracheostomy timing: zero to three days, four to seven days, and greater than seven days postadmission. TBI patients were stratified by the Glasgow Coma Scale (GCS), and non-TBI patients were stratified by the Injury Severity Score (ISS). The primary outcome was ventilator-free days (VFDs). Significance was defined as P < 0.05. Two hundred eighty-nine trauma patients met the study criteria: 151 had TBI (55.2%) versus 138 (47.8%) non-TBI. There were no significant differences in demographics within and between groups. In TBI patients, statistically significant increases in VFDs were observed with GCS 13 to 15 for tracheostomies performed in four to seven versus greater than seven days ( P = 0.005). For GCS <8 and 8 to 12, there were significant increases in VFDs for tracheostomies performed at days 1 to 3 and 4 to 7 versus greater than seven days (P << 0.05 for both). For non-TBI tracheostomies, only ISS ≥ 25 with tracheostomies performed at zero to three days versus greater than seven days was associated with improved VFDs. Early tracheostomies in TBI patients were associated with improved VFDs. In trauma patients with no TBI, early tracheostomy was associated with improved VFDs only in patients with ISS ≥ 25. Future research studies should investigate reasons TBI and non-TBI patients may differ.

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Anemia and Blood Transfusion in Patients with Isolated Traumatic Brain Injury

Critical Care Research and Practice ◽

10.1155/2015/672639 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Hasan M. Al-Dorzi ◽

Waleed Al-Humaid ◽

Hani M. Tamim ◽

Samir Haddad ◽

Ahmad Aljabbary ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Blood Transfusion ◽

Hospital Mortality ◽

Injury Severity ◽

Tertiary Care ◽

Hemoglobin Level ◽

Secondary Insult ◽

The Impact ◽

Present On Admission

Rationale. By reducing cerebral oxygen delivery, anemia may aggravate traumatic brain injury (TBI) secondary insult. This study evaluated the impact of anemia and blood transfusion on TBI outcomes.Methods. This was a retrospective cohort study of adult patients with isolated TBI at a tertiary-care intensive care unit from 1/1/2000 to 31/12/2011. Daily hemoglobin level and packed red blood cell (PRBC) transfusion were recorded. Patients with hemoglobin < 10 g/dL during ICU stay (anemic group) were compared with other patients.Results. Anemia was present on admission in two (2%) patients and developed in 48% during the first week with hemoglobin < 7 g/dL occurring in 3.0%. Anemic patients had higher admission Injury Severity Score and underwent more craniotomy (50% versus 13%,p<0.001). Forty percent of them received PRBC transfusion (2.8 ± 1.5 units per patient, median pretransfusion hemoglobin = 8.8 g/dL). Higher hospital mortality was associated with anemia (25% versus 6% for nonanemic patients,p=0.01) and PRBC transfusion (38% versus 9% for nontransfused patients,p=0.003). On multivariate analysis, only PRBC transfusion independently predicted hospital mortality (odds ratio: 6.8; 95% confidence interval: 1.1–42.3).Conclusions. Anemia occurred frequently after isolated TBI, but only PRBC transfusion independently predicted mortality.

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P.184 Off-road vehicle fatalities and alcohol in patients with major traumatic brain injury: the risk of impaired driving

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.460 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S73-S73

Author(s):

S Walling ◽

N Kureshi ◽

DB Clarke ◽

M Erdogan ◽

RS Green

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Injury Severity ◽

Alcohol Intoxication ◽

Blood Alcohol Concentration ◽

Significant Risk ◽

Road Vehicle ◽

Hospital Deaths ◽

The Impact

Background: Intoxicated patients injured in off road vehicle (ORV) crashes have higher rates of traumatic brain injury (TBI) and intensive care unit (ICU) admission, as well as prolonged ICU length of stay. This study evaluated the impact of alcohol intoxication on mortality among major TBI patients injured in off-road vehicle crashes. Methods: A retrospective analysis (2002-2014) of off-road vehicle injuries in Nova Scotia resulting in major TBI was performed. ORVs included ATVs, snowmobiles, and dirt bikes. A logistic regression model was constructed to test for in-hospital mortality and adjusted for age, Abbreviated Injury Scale (AIS) Head, Injury Severity Score, and blood alcohol concentration (BAC). Results: There were 176 drivers and passengers of off-road vehicles. Overall mortality was 28%. BAC testing was performed in 61% patients; 85% of pre-hospital deaths were BAC positive (mean BAC=31 ± 17.39 mmol/L) and 70% in-hospital deaths were BAC positive (mean BAC=26 ± 23.12 mmol/L). After adjusting for confounders, high injury severity and intoxication increased the likelihood of in-hospital mortality. Conclusions: These findings demonstrate that alcohol intoxication is a significant risk factor for mortality among off-road vehicle collisions; for every mmol/L change in BAC, there was a 10% increase in the chance of in-hospital mortality.

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Effects of Systematic Categorization Training on Cognitive Performance in Healthy Older Adults and in Adults with Traumatic Brain Injury

Behavioural Neurology ◽

10.1155/2019/9785319 ◽

2019 ◽

Vol 2019 ◽

pp. 1-17

Author(s):

Fofi Constantinidou

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Young Adults ◽

Brain Injury ◽

Cognitive Rehabilitation ◽

Neuropsychological Testing ◽

Cognitive Learning ◽

Cognitive Stimulation ◽

Future Research ◽

Control Group

This study investigated the effects of hierarchical cognitive training using the categorization program (CP), designed initially for adults with cognitive deficits associated with traumatic brain injury (TBI). Fifty-eight participants were included: a group of fifteen young adults with TBI (ages 18-48), another group of fifteen noninjured young adults (ages 18-50), and two groups of adults over 60 randomly assigned into the experimental group (n=14) or the control group (n=14). Following neuropsychological testing, the two young adult groups and the experimental older adult group received the CP training for 10-12 weeks. The CP training consisted of 8 levels targeting concept formation, object categorization, and decision-making abilities. Two CP tests (administered before and after the training) and three probe tasks (administered at specified intervals during the training) assessed skills relating to categorization. All treated groups showed significant improvement in their categorization performance, although younger participants (with or without TBI) demonstrated greater gains. Gains on the categorization measures were maintained by a subgroup of older adults up to four months posttraining. Implications of these findings in terms of adult cognitive learning and directions for future research on adult cognitive rehabilitation and cognitive stimulation programs are discussed.

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Age-related differences in the impact of coagulopathy in patients with isolated traumatic brain injury: an observational cohort study

10.21203/rs.2.19876/v1 ◽

2020 ◽

Author(s):

Wataru Takayama ◽

Akira Endo ◽

Hazuki Koguchi ◽

Kiyoshi Murata ◽

Yasuhiro Otomo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

The Elderly ◽

International Normalized Ratio ◽

Elderly Group ◽

Age Related ◽

Correlation Degree ◽

Observational Cohort ◽

The Impact

Abstract Background Although age and trauma-induced coagulopathy (TIC) are well-known predictors of poor outcome after traumatic brain injury (TBI), the interaction effect of these two predictors remains unclear.Objectives We assessed age-related differences in the impact of TIC on the outcome following isolated TBI.Methods We conducted a retrospective observational study in two tertiary emergency critical care medical centers in Japan from 2013 to 2018. A total of 1036 patients with isolated TBI [head abbreviated injury scale (AIS) ≥3, and other AIS <3] were selected, and divided into the non-elderly (n = 501, 16-64 years) and elderly group (n = 535, age ≥65 years). We further evaluated the impact of coagulopathy (international normalized ratio ≥1.2, and/or platelet count <120 × 10 9 /L, and/or fibrinogen ≤150 mg/dL) on TBI outcomes [Glasgow Outcome Scale-Extended (GOS-E) scores, in-hospital mortality, and ventilation-free days (VFD)] in both groups using univariate and multivariate models. Further, we conducted an age-based assessment of the impact of coagulopathy on GOS-E using a generalized additive model.Results The multivariate model showed a significant association of age and coagulopathy with lower GOS-E scores, in-hospital mortality, and shorter VFD in the non-elderly group; however, significant impact of coagulopathy was not observed for all the outcomes in the elderly group. There was a decrease in the correlation degree between coagulopathy and GOS-E scores decreased with age over 65 years old.Conclusions There was a low impact of coagulopathy on functional and survival outcomes in geriatric patients with isolated TBI.

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