The association of trauma center transport and long‐term functional outcomes in head‐injured older adults transported by EMS

The association of trauma center transport and long‐term functional outcomes in head‐injured older adults transported by EMS:

Abstract

Objective

It is unclear if trauma center care is associated with improved outcomes in older adults with traumatic brain injury (TBI) compared to management at non‐trauma centers. Our primary objectives were to describe the long‐term outcomes of older adults with TBI and to evaluate the association of trauma center transport with long‐term functional outcome.

Methods

This was a prospective, observational study at 5 EMS agencies and 11 hospitals representing all 911 transfers within a county. Older adults (≥55 years) with TBI (defined as closed head injury associated with loss of consciousness and/or amnesia, or abnormal Glasgow Coma Scale [GCS] score, or traumatic intracranial hemorrhage) and transported by EMS from Aug 2015 to Sept 2016 were eligible. EMS providers completed standardized data forms and emergency department (ED) and hospital data were abstracted. Functional outcomes were measured using the Extended Glasgow Outcome Scale (GOS‐E) at 3 month and 6 months intervals by telephone follow up. Reasons for disabilities were coded as due to head injury, due to illness or injury to other part of body, or a mixture of both. To evaluate the association of trauma center transport and functional outcomes, we conducted multivariate ordinal logistic regression analyses on multiple imputed data for 1) all patients with TBI and 2) patients with traumatic intracranial hemorrhage.

Results

We enrolled 350 patients with TBI; the median age was 70 years (Q1, Q3: 61, 84 years), 187 (53%) were male, and 91 patients (26%) had traumatic intracranial hemorrhage on initial ED cranial computed tomography (CT) imaging. Two hundred fifty‐seven patients (73%) were transported by EMS to a Level 1 or 2 trauma center. Sixty‐nine patients (20%) did not complete follow up at 3 or 6 months. Of the patients with follow up, 119/260 patients (46%) had moderate disability or worse at 6 months, including 55/260 patients (21%) who were dead at 6 month follow up. Death or severe disabilities were more commonly attributed to non‐TBI causes while moderate disabilities or better were more commonly due to TBI. On adjusted analysis, an abnormal Glasgow Coma Scale (GCS) score, higher Charlson comorbidity index scores, and the presence of traumatic intracranial hemorrhage on initial ED cranial imaging were associated with worse GOS‐E scores at 6 months. Trauma center transport was not associated with GOS‐E scores at 6 months for TBI patients and in patients with traumatic intracranial hemorrhage on initial ED CT imaging.

Conclusions

In older adults with TBI, moderate disability or worse is common 6 months after injury. Over 1 in 5 of older adults with TBI died by 6 months, usually due to non‐head causes. Patients with TBI or traumatic intracranial hemorrhage did not have improved functional outcomes with initial triage to a trauma center.