<p>Antidepressants and the risk of traumatic brain injury in the elderly: differences between individual agents</p>

Self-reported complaints are common after mild traumatic brain injury (mTBI). Particularly in the elderly with mTBI, the pre-injury status might play a relevant role in the recovery process. In most mTBI studies, however, pre-injury complaints are neither analyzed nor are the elderly included. Here, we aimed to identify which individual pre- and post-injury complaints are potential prognostic markers for incomplete recovery (IR) in elderly patients who sustained an mTBI. Since patients report many complaints across several domains that are strongly related, we used an interpretable machine learning (ML) approach to robustly deal with correlated predictors and boost classification performance. Pre- and post-injury levels of 20 individual complaints, as self-reported in the acute phase, were analyzed. We used data from two independent studies separately: UPFRONT study was used for training and validation and ReCONNECT study for independent testing. Functional outcome was assessed with the Glasgow Outcome Scale Extended (GOSE). We dichotomized functional outcome into complete recovery (CR; GOSE = 8) and IR (GOSE ≤ 7). In total 148 elderly with mTBI (median age: 67 years, interquartile range [IQR]: 9 years; UPFRONT: N = 115; ReCONNECT: N = 33) were included in this study. IR was observed in 74 (50%) patients. The classification model (IR vs. CR) achieved a good performance (the area under the receiver operating characteristic curve [ROC-AUC] = 0.80; 95% CI: 0.74–0.86) based on a subset of only 8 out of 40 pre- and post-injury complaints. We identified increased neck pain (p = 0.001) from pre- to post-injury as the strongest predictor of IR, followed by increased irritability (p = 0.011) and increased forgetfulness (p = 0.035) from pre- to post-injury. Our findings indicate that a subset of pre- and post-injury physical, emotional, and cognitive complaints has predictive value for determining long-term functional outcomes in elderly patients with mTBI. Particularly, post-injury neck pain, irritability, and forgetfulness scores were associated with IR and should be assessed early. The application of an ML approach holds promise for application in self-reported questionnaires to predict outcomes after mTBI.

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Outcome following traumatic brain injury in the elderly: a critical review

Brain Injury ◽

10.1080/026990500413777 ◽

2000 ◽

Vol 14 (8) ◽

pp. 749-761 ◽

Cited By ~ 35

Author(s):

Mark J. Rapoport, Anthony Feinstein

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Critical Review ◽

The Elderly

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Age-Related Differences in the Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury

International Journal of Molecular Sciences ◽

10.3390/ijms21165613 ◽

2020 ◽

Vol 21 (16) ◽

pp. 5613

Author(s):

Ryuta Nakae ◽

Yu Fujiki ◽

Yasuhiro Takayama ◽

Takahiro Kanaya ◽

Yutaka Igarashi ◽

...

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Propensity Score ◽

Older Patients ◽

Multivariate Logistic Regression Analysis ◽

The Elderly ◽

Elderly Group ◽

Post Injury ◽

D Dimer

Coagulopathy and older age are common and well-recognized risk factors for poorer outcomes in traumatic brain injury (TBI) patients; however, the relationships between coagulopathy and age remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more pronounced in older patients and may be a factor in poorer outcomes. We retrospectively evaluated severe TBI cases in which fibrinogen and D-dimer were measured on arrival and 3–6 h after injury. Propensity score-matched analyses were performed to adjust baseline characteristics between older patients (the “elderly group,” aged ≥75 y) and younger patients (the “non-elderly group,” aged 16–74 y). A total of 1294 cases (elderly group: 395, non-elderly group: 899) were assessed, and propensity score matching created a matched cohort of 324 pairs. Fibrinogen on admission, the degree of reduction in fibrinogen between admission and 3–6 h post-injury, and D-dimer levels between admission and 3–6 h post-injury were significantly more abnormal in the elderly group than in the non-elderly group. On multivariate logistic regression analysis, independent risk factors for poor prognosis included low fibrinogen and high D-dimer levels on admission. Posttraumatic coagulation and fibrinolytic abnormalities are more severe in older patients, and fibrinogen and D-dimer abnormalities are negative predictive factors.

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Poster 14: Increasing Incidence of Traumatic Brain Injury in the Elderly

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2007.06.574 ◽

2007 ◽

Vol 88 (9) ◽

pp. E13-E14

Author(s):

Elliot B. Bodofsky ◽

Frank Camaratta

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

The Elderly

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Poster 13 consequences of traumatic brain injury in the elderly. Julie A. Testa, PhD (Mayo Clinic, Rochester, MN), James F. Malec, PhD, ABPP

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2004.06.027 ◽

2004 ◽

Vol 85 (8) ◽

pp. e7-e8

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mayo Clinic ◽

The Elderly

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Neurointensive care of traumatic brain injury in the elderly—age-specific secondary insult levels and optimal physiological levels to target need to be defined

Acta Neurochirurgica ◽

10.1007/s00701-021-05047-z ◽

2021 ◽

Author(s):

Samuel Lenell ◽

Anders Lewén ◽

Timothy Howells ◽

Per Enblad

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

The Elderly ◽

Favorable Outcome ◽

Neurointensive Care ◽

Younger Patients ◽

Secondary Insults ◽

Secondary Insult ◽

Monitoring Time ◽

The Impact

Abstract Background Elderly patients with traumatic brain injury increase. Current targets and secondary insult definitions during neurointensive care (NIC) are mostly based on younger patients. The aim was therefore to study the occurrence of predefined secondary insults and the impact on outcome in different ages with particular focus on elderly. Methods Patients admitted to Uppsala 2008–2014 were included. Patient characteristics, NIC management, monitoring data, and outcome were analyzed. The percentage of monitoring time for ICP, CPP, MAP, and SBP above-/below-predefined thresholds was calculated. Results Five hundred seventy patients were included, 151 elderly ≥ 65 years and 419 younger 16–64 years. Age ≥ 65 had significantly higher percentage of CPP > 100, MAP > 120, and SBP > 180 and age 16–64 had higher percentage of ICP ≥ 20, CPP ≤ 60, and MAP ≤ 80. Age ≥ 65 contributed independently to the different secondary insult patterens. When patients in all ages were analyzed, low percentage of CPP > 100 and SBP > 180, respectively, was significant predictors of favorable outcome and high percentage of ICP ≥ 20, CPP > 100, SBP ≤ 100, and SBP > 180, respectively, was predictors of death. Analysis of age interaction showed that patients ≥ 65 differed and had a higher odds for favorable outcome with large proportion of good monitoring time with SBP > 180. Conclusions Elderly ≥ 65 have different patterns of secondary insults/physiological variables, which is independently associated to age. The finding that SBP > 180 increased the odds of favorable outcome in the elderly but decreased the odds in younger patients may indicate that blood pressure should be treated differently depending on age.

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Incidence, causes and consequences of moderate and severe traumatic brain injury as determined by Abbreviated Injury Score in the Netherlands

Scientific Reports ◽

10.1038/s41598-021-99484-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Denise Jochems ◽

Eveline van Rein ◽

Menco Niemeijer ◽

Mark van Heijl ◽

Michael A. van Es ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

The Netherlands ◽

Traffic Accidents ◽

Road Traffic ◽

The Elderly ◽

National Database ◽

Target Prevention ◽

Severe Tbi ◽

Polytrauma Patients

AbstractTraumatic brain injury (TBI) is a leading cause of death and disability. Epidemiology seems to be changing. TBIs are increasingly caused by falls amongst elderly, whilst we see less polytrauma due to road traffic accidents (RTA). Data on epidemiology is essential to target prevention strategies. A nationwide retrospective cohort study was conducted. The Dutch National Trauma Database was used to identify all patients over 17 years old who were admitted to a hospital with moderate and severe TBI (AIS ≥ 3) in the Netherlands from January 2015 until December 2017. Subgroup analyses were done for the elderly and polytrauma patients. 12,295 patients were included in this study. The incidence of moderate and severe TBI was 30/100.000 person-years, 13% of whom died. Median age was 65 years and falls were the most common trauma mechanism, followed by RTAs. Amongst elderly, RTAs consisted mostly of bicycle accidents. Mortality rates were higher for elderly (18%) and polytrauma patients (24%). In this national database more elderly patients who most often sustained the injury due to a fall or an RTA were seen. Bicycle accidents were very frequent, suggesting prevention could be an important aspect in order to decrease morbidity and mortality.

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P.088 Antithrombotic agents and traumatic brain injury in the elderly population: hemorrhage patterns and outcomes

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

10.1017/cjn.2018.190 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S39-S39

Author(s):

P Scotti ◽

J Troquet ◽

C Seguin ◽

B Lo ◽

J Marcoux

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Trauma ◽

Elderly Population ◽

The Elderly ◽

International Normalized Ratio ◽

Trauma Patients ◽

Surgical Interventions ◽

Risk Of Mortality ◽

Elderly Trauma Patients

Background: In the elderly population, use of antithrombotic therapy (AT), antiplatelets (AP – aspirin, clopidogrel) and/or anticoagulants (AC – warfarin, DoAC – Dabigatran, Rivaroxaban, Apixaban), to prevent thrombo-embolic events must be carefully weighed against the risk of intracranial hemorrhage (ICH) with trauma. We hypothesize that for all patients 65yro+ with head trauma, those on AT will be more likely to sustain a traumatic brain injury, ICH, and poorer outcomes. Methods: Data was collected from all head trauma patients 65yo+ presenting to our tertiary trauma center (level 1) over a 24-month period; age, gender, injury mechanism, medications, International Normalized Ratio, reversal therapy, Glasgow Coma Scale (GCS), ICH, surgery, Extended Glasgow Outcome Scale score (GOSE) and mortality. Results: 1365 patients were identified; 724 on AT (413 AP, 151 AC, 59 DoAC, 48 2AP, 38 AP+AC, 15 AP+DoAC) and 474 not (non-AT). When adjusted for covariates, AT patients were more likely to have ICH (p=0.0004), more invasive surgical interventions (p=0.0188), functional dependency (GOSE≤4; p<0.0001) and mortality (p<0.0001). Risk of mortality is notably high with 2AP (OR 5.74; p=0.0003) and AC+AP (OR 4.12; p=0.0118). Conclusions: Elderly trauma patients on AT, especially combination therapy, have higher risks of ICH and poorer outcomes compared to those who are not.

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Antithrombotic agents and traumatic brain injury in the elderly population: hemorrhage patterns and outcomes

Journal of Neurosurgery ◽

10.3171/2019.4.jns19252 ◽

2020 ◽

Vol 133 (2) ◽

pp. 486-495 ◽

Cited By ~ 8

Author(s):

Pasquale Scotti ◽

Chantal Séguin ◽

Benjamin W. Y. Lo ◽

Elaine de Guise ◽

Jean-Marc Troquet ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Trauma ◽

Ct Scanning ◽

The Elderly ◽

International Normalized Ratio ◽

Trauma Patients ◽

Risk Of Falls ◽

Gcs Score

OBJECTIVEAmong the elderly, use of antithrombotics (ATs), antiplatelets (APs; aspirin, clopidogrel), and/or anticoagulants (ACs; warfarin, direct oral ACs [DOACs; dabigatran, rivaroxaban, apixaban]) to prevent thromboembolic events must be carefully weighed against the risk of intracranial hemorrhage (ICH) with trauma. The goal of this study was to assess the risk of sustaining a traumatic brain injury (TBI), ICH, and poorer outcomes in relation to AT use among all patients 65 years or older presenting to a single institution with head trauma.METHODSData were collected from all head trauma patients 65 years or older presenting to the authors’ supraregional tertiary trauma center over a 24-month period and included age, sex, injury mechanism, medical history, international normalized ratio, Glasgow Coma Scale (GCS) score, ICH presence and type, hospital admission, reversal therapy, surgery, discharge destination, Extended Glasgow Outcome Scale (GOSE) score at discharge, and mortality.RESULTSA total of 1365 head trauma patients 65 years or older were included; 724 were on AT therapy (413 on APs, 151 on ACs, 59 on DOACs, 48 on 2 APs, 38 on AP+AC, and 15 on AP+DOAC) and 641 were not. Among all head trauma patients, the risk of sustaining a TBI was associated with AP use after adjusting for covariates. Of the 731 TBI patients, those using ATs had higher rates of ICH (p <0.0001), functional dependency at discharge (GOSE score ≤ 4; p < 0.0001), and mortality (p < 0.0001). Elevated rates of ICH progression on follow-up CT scanning were observed in patients in the warfarin monotherapy (OR 5.30, p < 0.0001) and warfarin + AP (OR 6.15, p = 0.0011). Risk of mortality was not associated with single antiplatelet use but was notably high with 2 APs (OR 4.66, p = 0.0056), warfarin (OR 5.18, p = 0.0003), and DOAC use (OR 5.09, p = 0.0149).CONCLUSIONSElderly trauma patients on ATs, especially combination therapy, are at elevated risk of ICH and poor outcomes compared with those not on AT therapy. While both AP and warfarin use alone and in combination were associated with significantly elevated odds of sustaining an ICH among TBI patients, only warfarin use was a predictor of hemorrhage progression on follow-up scans. The use of a single AP was not associated with mortality; however, the combination of both aspirin and clopidogrel was. Warfarin and DOAC users had comparable mortality rates; however, DOAC users had lower rates of ICH progression, and fewer survivors were functionally dependent at discharge than were warfarin users. DOACs are an overall safer alternative to warfarin for patients at high risk of falls.

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