Intensity of treatment, end-of-life care, and mortality for older patients with severe traumatic brain injury

BACKGROUND: The Eastern Association for the Surgery of Trauma (EAST) recommends that clinicians consider limiting further aggressive treatment in geriatric patients with severe TBI who do not improve in 72 hours (non-responders) due to their poor prognosis. However, little is known about how these guidelines are followed in practice. This study compared mortality and patient care among geriatric patients with severe TBI classified as "responders" and "non-responders" 72 hours after injury. METHODS: Retrospective review of patients ≥65 years old at a Level I Trauma Center with severe TBI (GCS8 at 72 hours) and non-responders (GCS>8 at 72 hours). RESULTS: Of 90 patients, 29 (32%) died within 3 days of injury; 29 (32%) were non-responders; and 32 (34%) were responders. An additional 19 (21%) patients died before hospital discharge, of whom 17 (89%) were non-responders. Non-responders had higher odds of in-hospital death (OR 31.8, 95% CI 3.71-272.9, p=0.002). Family meetings to discuss goals of care were more common in the non-responder group (pCONCLUSION: The responder/non-responder dichotomy identifies patients with higher in-hospital mortality outcomes and is associated with differences in EOL decision-making. However, functional impairment and poor survival were prevalent, irrespective of neurologic status at 72 hours. LEVEL OF EVIDENCE: Level III STUDY TYPE: Prognostic and Epidemiological. Language: en