The effect of age on functional outcome in mild traumatic brain injury: 6-Month report of a prospective multicenter trial

Anne C. Mosenthal, David H. Livingston, Robert F. Lavery, Margaret M. Knudson, Seong Lee, Diane Morabito, Geoffrey T. Manley, Avery Nathens, Gregory Jurkovich, David B. Hoyt, Raul Coimbra

Research output: Contribution to journalArticle

166 Citations (Scopus)

Abstract

Objective: Elderly patients (aged 60 years and older) have been demonstrated to have an increased mortality after isolated traumatic brain injury (TBI); however, the prognosis of those patients surviving their hospitalization is unknown. We hypothesized that surviving elderly patients would also have decreased functional outcome, and this study examined the functional outcome of patients with isolated TBI at discharge and at 6 months posthospitalization. Methods: This was a multicenter prospective study of all patients with isolated moderate to severe TBI defined as Head Abbreviated Injury Scale score of 3 with an Abbreviated Injury Scale score in any other body area of 1. Patients surviving to discharge gave their consent and were enrolled. Data collected included demographics, Glasgow Coma Scale (GCS) score at admission, and neurosurgical interventions. Outcome data included discharge disposition and Glasgow Outcome Scale score and modified Functional Independence Measure (FIM) score at discharge and at 6 months. Results: Two hundred thirty-five patients were enrolled, with 44 (19%) aged greater than or equal to 65 years. Mechanisms of injury were falls (34%), assaults (28%), motor vehicle collisions (14%), pedestrian (11%), and other (12%). Falls were more common in the older patients and assaults in the younger group. The mean admitting GCS score was 12.8 (95% confidence interval [CI], 12.4-13.3), with older patients having a higher mean GCS score, 14.1 (95% CI, 13.6-14.6) versus 12.5 (95% CI, 12.0-13.1; p = 0.03). There were no differences in the percentage of patients admitted to the intensive care unit or requiring neurosurgical intervention between younger and older patients. Because there were few elderly patients with low GCS scores who survived to discharge, outcome measures focused on those patients with GCS scores of 13 to 15. A greater percentage of elderly were discharged to rehabilitation (28% vs. 16 %, p = 0.08). The mean discharge FIM score was 10.4 (95% CI, 9.8-11.0) for the elderly versus 11.4 (95% CI, 11.1-11.7) for the young (p = 0.001), with 68% elderly and 89% young discharged with total independent scores of 11 to 12. At 6 months, the difference narrowed, but the mean FIM score was still greater for the young group, 11.7 (95% CI, 11.6-11.9) versus 11.0 (95% CI, 10.6-11.4; p < 0.001). Conclusion: Functional outcome after isolated mild TBI as measured by the Glasgow Outcome Scale and modified FIM is generally good to excellent for both elderly and younger patients. Older patients required more inpatient rehabilitation and lagged behind their younger counterparts but continued to recover and improve after discharge. Although there were statistically significant differences in the FIM score at both discharge and 6 months, the clinical importance of these small differences in the mean FIM score to the patient's quality of life is less clear. Measurable improvement in functional status during the first 6 months after injury is observed in both groups. Aggressive management and care of older patients with TBI is warranted, and efforts should be made to decrease inpatient mortality. Continued follow-up is ongoing to determine whether these outcomes persist at 12 months.

Original languageEnglish (US)
Pages (from-to)1042-1048
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume56
Issue number5
DOIs
StatePublished - Jan 1 2004
Externally publishedYes

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Brain Concussion
Multicenter Studies
Glasgow Coma Scale
Confidence Intervals
Abbreviated Injury Scale
Glasgow Outcome Scale
Inpatients
Rehabilitation
Patient Care Management
Outcome Assessment (Health Care)

Keywords

  • Elderly
  • Functional outcome
  • Mortality
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The effect of age on functional outcome in mild traumatic brain injury : 6-Month report of a prospective multicenter trial. / Mosenthal, Anne C.; Livingston, David H.; Lavery, Robert F.; Knudson, Margaret M.; Lee, Seong; Morabito, Diane; Manley, Geoffrey T.; Nathens, Avery; Jurkovich, Gregory; Hoyt, David B.; Coimbra, Raul.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 56, No. 5, 01.01.2004, p. 1042-1048.

Research output: Contribution to journalArticle

Mosenthal, AC, Livingston, DH, Lavery, RF, Knudson, MM, Lee, S, Morabito, D, Manley, GT, Nathens, A, Jurkovich, G, Hoyt, DB & Coimbra, R 2004, 'The effect of age on functional outcome in mild traumatic brain injury: 6-Month report of a prospective multicenter trial', Journal of Trauma - Injury, Infection and Critical Care, vol. 56, no. 5, pp. 1042-1048. https://doi.org/10.1097/01.TA.0000127767.83267.33
Mosenthal, Anne C. ; Livingston, David H. ; Lavery, Robert F. ; Knudson, Margaret M. ; Lee, Seong ; Morabito, Diane ; Manley, Geoffrey T. ; Nathens, Avery ; Jurkovich, Gregory ; Hoyt, David B. ; Coimbra, Raul. / The effect of age on functional outcome in mild traumatic brain injury : 6-Month report of a prospective multicenter trial. In: Journal of Trauma - Injury, Infection and Critical Care. 2004 ; Vol. 56, No. 5. pp. 1042-1048.
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abstract = "Objective: Elderly patients (aged 60 years and older) have been demonstrated to have an increased mortality after isolated traumatic brain injury (TBI); however, the prognosis of those patients surviving their hospitalization is unknown. We hypothesized that surviving elderly patients would also have decreased functional outcome, and this study examined the functional outcome of patients with isolated TBI at discharge and at 6 months posthospitalization. Methods: This was a multicenter prospective study of all patients with isolated moderate to severe TBI defined as Head Abbreviated Injury Scale score of 3 with an Abbreviated Injury Scale score in any other body area of 1. Patients surviving to discharge gave their consent and were enrolled. Data collected included demographics, Glasgow Coma Scale (GCS) score at admission, and neurosurgical interventions. Outcome data included discharge disposition and Glasgow Outcome Scale score and modified Functional Independence Measure (FIM) score at discharge and at 6 months. Results: Two hundred thirty-five patients were enrolled, with 44 (19{\%}) aged greater than or equal to 65 years. Mechanisms of injury were falls (34{\%}), assaults (28{\%}), motor vehicle collisions (14{\%}), pedestrian (11{\%}), and other (12{\%}). Falls were more common in the older patients and assaults in the younger group. The mean admitting GCS score was 12.8 (95{\%} confidence interval [CI], 12.4-13.3), with older patients having a higher mean GCS score, 14.1 (95{\%} CI, 13.6-14.6) versus 12.5 (95{\%} CI, 12.0-13.1; p = 0.03). There were no differences in the percentage of patients admitted to the intensive care unit or requiring neurosurgical intervention between younger and older patients. Because there were few elderly patients with low GCS scores who survived to discharge, outcome measures focused on those patients with GCS scores of 13 to 15. A greater percentage of elderly were discharged to rehabilitation (28{\%} vs. 16 {\%}, p = 0.08). The mean discharge FIM score was 10.4 (95{\%} CI, 9.8-11.0) for the elderly versus 11.4 (95{\%} CI, 11.1-11.7) for the young (p = 0.001), with 68{\%} elderly and 89{\%} young discharged with total independent scores of 11 to 12. At 6 months, the difference narrowed, but the mean FIM score was still greater for the young group, 11.7 (95{\%} CI, 11.6-11.9) versus 11.0 (95{\%} CI, 10.6-11.4; p < 0.001). Conclusion: Functional outcome after isolated mild TBI as measured by the Glasgow Outcome Scale and modified FIM is generally good to excellent for both elderly and younger patients. Older patients required more inpatient rehabilitation and lagged behind their younger counterparts but continued to recover and improve after discharge. Although there were statistically significant differences in the FIM score at both discharge and 6 months, the clinical importance of these small differences in the mean FIM score to the patient's quality of life is less clear. Measurable improvement in functional status during the first 6 months after injury is observed in both groups. Aggressive management and care of older patients with TBI is warranted, and efforts should be made to decrease inpatient mortality. Continued follow-up is ongoing to determine whether these outcomes persist at 12 months.",
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TY - JOUR

T1 - The effect of age on functional outcome in mild traumatic brain injury

T2 - 6-Month report of a prospective multicenter trial

AU - Mosenthal, Anne C.

AU - Livingston, David H.

AU - Lavery, Robert F.

AU - Knudson, Margaret M.

AU - Lee, Seong

AU - Morabito, Diane

AU - Manley, Geoffrey T.

AU - Nathens, Avery

AU - Jurkovich, Gregory

AU - Hoyt, David B.

AU - Coimbra, Raul

PY - 2004/1/1

Y1 - 2004/1/1

N2 - Objective: Elderly patients (aged 60 years and older) have been demonstrated to have an increased mortality after isolated traumatic brain injury (TBI); however, the prognosis of those patients surviving their hospitalization is unknown. We hypothesized that surviving elderly patients would also have decreased functional outcome, and this study examined the functional outcome of patients with isolated TBI at discharge and at 6 months posthospitalization. Methods: This was a multicenter prospective study of all patients with isolated moderate to severe TBI defined as Head Abbreviated Injury Scale score of 3 with an Abbreviated Injury Scale score in any other body area of 1. Patients surviving to discharge gave their consent and were enrolled. Data collected included demographics, Glasgow Coma Scale (GCS) score at admission, and neurosurgical interventions. Outcome data included discharge disposition and Glasgow Outcome Scale score and modified Functional Independence Measure (FIM) score at discharge and at 6 months. Results: Two hundred thirty-five patients were enrolled, with 44 (19%) aged greater than or equal to 65 years. Mechanisms of injury were falls (34%), assaults (28%), motor vehicle collisions (14%), pedestrian (11%), and other (12%). Falls were more common in the older patients and assaults in the younger group. The mean admitting GCS score was 12.8 (95% confidence interval [CI], 12.4-13.3), with older patients having a higher mean GCS score, 14.1 (95% CI, 13.6-14.6) versus 12.5 (95% CI, 12.0-13.1; p = 0.03). There were no differences in the percentage of patients admitted to the intensive care unit or requiring neurosurgical intervention between younger and older patients. Because there were few elderly patients with low GCS scores who survived to discharge, outcome measures focused on those patients with GCS scores of 13 to 15. A greater percentage of elderly were discharged to rehabilitation (28% vs. 16 %, p = 0.08). The mean discharge FIM score was 10.4 (95% CI, 9.8-11.0) for the elderly versus 11.4 (95% CI, 11.1-11.7) for the young (p = 0.001), with 68% elderly and 89% young discharged with total independent scores of 11 to 12. At 6 months, the difference narrowed, but the mean FIM score was still greater for the young group, 11.7 (95% CI, 11.6-11.9) versus 11.0 (95% CI, 10.6-11.4; p < 0.001). Conclusion: Functional outcome after isolated mild TBI as measured by the Glasgow Outcome Scale and modified FIM is generally good to excellent for both elderly and younger patients. Older patients required more inpatient rehabilitation and lagged behind their younger counterparts but continued to recover and improve after discharge. Although there were statistically significant differences in the FIM score at both discharge and 6 months, the clinical importance of these small differences in the mean FIM score to the patient's quality of life is less clear. Measurable improvement in functional status during the first 6 months after injury is observed in both groups. Aggressive management and care of older patients with TBI is warranted, and efforts should be made to decrease inpatient mortality. Continued follow-up is ongoing to determine whether these outcomes persist at 12 months.

AB - Objective: Elderly patients (aged 60 years and older) have been demonstrated to have an increased mortality after isolated traumatic brain injury (TBI); however, the prognosis of those patients surviving their hospitalization is unknown. We hypothesized that surviving elderly patients would also have decreased functional outcome, and this study examined the functional outcome of patients with isolated TBI at discharge and at 6 months posthospitalization. Methods: This was a multicenter prospective study of all patients with isolated moderate to severe TBI defined as Head Abbreviated Injury Scale score of 3 with an Abbreviated Injury Scale score in any other body area of 1. Patients surviving to discharge gave their consent and were enrolled. Data collected included demographics, Glasgow Coma Scale (GCS) score at admission, and neurosurgical interventions. Outcome data included discharge disposition and Glasgow Outcome Scale score and modified Functional Independence Measure (FIM) score at discharge and at 6 months. Results: Two hundred thirty-five patients were enrolled, with 44 (19%) aged greater than or equal to 65 years. Mechanisms of injury were falls (34%), assaults (28%), motor vehicle collisions (14%), pedestrian (11%), and other (12%). Falls were more common in the older patients and assaults in the younger group. The mean admitting GCS score was 12.8 (95% confidence interval [CI], 12.4-13.3), with older patients having a higher mean GCS score, 14.1 (95% CI, 13.6-14.6) versus 12.5 (95% CI, 12.0-13.1; p = 0.03). There were no differences in the percentage of patients admitted to the intensive care unit or requiring neurosurgical intervention between younger and older patients. Because there were few elderly patients with low GCS scores who survived to discharge, outcome measures focused on those patients with GCS scores of 13 to 15. A greater percentage of elderly were discharged to rehabilitation (28% vs. 16 %, p = 0.08). The mean discharge FIM score was 10.4 (95% CI, 9.8-11.0) for the elderly versus 11.4 (95% CI, 11.1-11.7) for the young (p = 0.001), with 68% elderly and 89% young discharged with total independent scores of 11 to 12. At 6 months, the difference narrowed, but the mean FIM score was still greater for the young group, 11.7 (95% CI, 11.6-11.9) versus 11.0 (95% CI, 10.6-11.4; p < 0.001). Conclusion: Functional outcome after isolated mild TBI as measured by the Glasgow Outcome Scale and modified FIM is generally good to excellent for both elderly and younger patients. Older patients required more inpatient rehabilitation and lagged behind their younger counterparts but continued to recover and improve after discharge. Although there were statistically significant differences in the FIM score at both discharge and 6 months, the clinical importance of these small differences in the mean FIM score to the patient's quality of life is less clear. Measurable improvement in functional status during the first 6 months after injury is observed in both groups. Aggressive management and care of older patients with TBI is warranted, and efforts should be made to decrease inpatient mortality. Continued follow-up is ongoing to determine whether these outcomes persist at 12 months.

KW - Elderly

KW - Functional outcome

KW - Mortality

KW - Traumatic brain injury

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