Chartelin Jean Isaac, Axel Benhamed, Valérie Boucher, Samuel Lauzon, Pierre-Gilles Blanchard, Christian Malo, Francis Bernard, Jean-Marc Chauny, Mélanie Bérubé, Eric Mercier, Amaury Gossiome, Myreille D'Astous, Marcel Émond
{"title":"老年中度外伤性脑损伤患者死亡率增高。","authors":"Chartelin Jean Isaac, Axel Benhamed, Valérie Boucher, Samuel Lauzon, Pierre-Gilles Blanchard, Christian Malo, Francis Bernard, Jean-Marc Chauny, Mélanie Bérubé, Eric Mercier, Amaury Gossiome, Myreille D'Astous, Marcel Émond","doi":"10.1007/s43678-025-00941-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Higher mortality has been reported in older patients with moderate traumatic brain Injuries (TBI) compared to younger patients. To identify the risk factors associated with in-hospital mortality, complications and extended length of stay in moderate TBI patients.</p><p><strong>Methods: </strong>DESIGN: a multicentre observational cohort study using the Quebec Trauma Registry.</p><p><strong>Population: </strong>Hospitalized patients aged ≥ 16 with a moderate TBI (a head injury with an Abbreviated Injury Scale (AIS) ≥ 3, and a GCS score of 9-12).</p><p><strong>Outcomes: </strong>In-hospital mortality, complications and prolonged length of stay.</p><p><strong>Analyses: </strong>Multivariable logistic regression.</p><p><strong>Results: </strong>We included 1005 patients, 38.1% of whom were aged ≥ 65. The in-hospital mortality rate was 20.1%. Male sex (OR = 1.6 [95% CI:1.02-2.6], age (≥ 85 years old VS < 65 years) (OR = 18.7 [95% CI: 9.2-38.1]), ≥ 2 comorbidities (OR = 2.3 [95% CI: 1.3-4.0]), Injury Severity Score (OR = 1.04 [95% CI: 1.01-1.1]), presence of intraparenchymal hematoma (OR = 3.5 [95% CI: 2.2-5.5]) or other CT scan findings (cerebral edema, pneumocephalus, subpial hemorrhage, and pituitary injury) (OR = 1.9 [95% CI: 1.2-3.1]) were associated with increased odds of mortality. Male sex (OR = 1.8 [95% CI: 1.2-2.6]), age (65-74: OR = 1.7 [95% CI: 1.1-2.8] & 75-84: OR = 1.6 [95% CI: 1.03-2.6]), ≥ 2 comorbidities (OR = 2.9 [95% CI: 1.8-4.7]), thoraco-abdominal concomitant injury (OR = 2.0 [95% CI: 1.01-3.8]), and subarachnoid hemorrhage (OR = 7.6 [95% CI:1.5-38.5]) were associated with increased odds of complications. The number of comorbidities (≥ 2 OR = 1.7 [95% CI: 1.1-2.7]), spine injury (OR = 2.4 [95% CI: 1.4-4.1]), and delirium (OR = 3.1 [95% CI:1.8-5.2]) were associated with an increased odd of extended length of stay.</p><p><strong>Conclusions: </strong>This study identified risk factors of in-hospital mortality, complications and extended length of stay, most of which are quickly available in the Emergency Department (ED). These factors could help clinicians identify moderate TBI patients at high risk of in-hospital mortality and guide shared decision-making regarding goals of care.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The increased mortality of older patients with moderate traumatic brain injury.\",\"authors\":\"Chartelin Jean Isaac, Axel Benhamed, Valérie Boucher, Samuel Lauzon, Pierre-Gilles Blanchard, Christian Malo, Francis Bernard, Jean-Marc Chauny, Mélanie Bérubé, Eric Mercier, Amaury Gossiome, Myreille D'Astous, Marcel Émond\",\"doi\":\"10.1007/s43678-025-00941-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Higher mortality has been reported in older patients with moderate traumatic brain Injuries (TBI) compared to younger patients. To identify the risk factors associated with in-hospital mortality, complications and extended length of stay in moderate TBI patients.</p><p><strong>Methods: </strong>DESIGN: a multicentre observational cohort study using the Quebec Trauma Registry.</p><p><strong>Population: </strong>Hospitalized patients aged ≥ 16 with a moderate TBI (a head injury with an Abbreviated Injury Scale (AIS) ≥ 3, and a GCS score of 9-12).</p><p><strong>Outcomes: </strong>In-hospital mortality, complications and prolonged length of stay.</p><p><strong>Analyses: </strong>Multivariable logistic regression.</p><p><strong>Results: </strong>We included 1005 patients, 38.1% of whom were aged ≥ 65. The in-hospital mortality rate was 20.1%. Male sex (OR = 1.6 [95% CI:1.02-2.6], age (≥ 85 years old VS < 65 years) (OR = 18.7 [95% CI: 9.2-38.1]), ≥ 2 comorbidities (OR = 2.3 [95% CI: 1.3-4.0]), Injury Severity Score (OR = 1.04 [95% CI: 1.01-1.1]), presence of intraparenchymal hematoma (OR = 3.5 [95% CI: 2.2-5.5]) or other CT scan findings (cerebral edema, pneumocephalus, subpial hemorrhage, and pituitary injury) (OR = 1.9 [95% CI: 1.2-3.1]) were associated with increased odds of mortality. Male sex (OR = 1.8 [95% CI: 1.2-2.6]), age (65-74: OR = 1.7 [95% CI: 1.1-2.8] & 75-84: OR = 1.6 [95% CI: 1.03-2.6]), ≥ 2 comorbidities (OR = 2.9 [95% CI: 1.8-4.7]), thoraco-abdominal concomitant injury (OR = 2.0 [95% CI: 1.01-3.8]), and subarachnoid hemorrhage (OR = 7.6 [95% CI:1.5-38.5]) were associated with increased odds of complications. The number of comorbidities (≥ 2 OR = 1.7 [95% CI: 1.1-2.7]), spine injury (OR = 2.4 [95% CI: 1.4-4.1]), and delirium (OR = 3.1 [95% CI:1.8-5.2]) were associated with an increased odd of extended length of stay.</p><p><strong>Conclusions: </strong>This study identified risk factors of in-hospital mortality, complications and extended length of stay, most of which are quickly available in the Emergency Department (ED). These factors could help clinicians identify moderate TBI patients at high risk of in-hospital mortality and guide shared decision-making regarding goals of care.</p>\",\"PeriodicalId\":93937,\"journal\":{\"name\":\"CJEM\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-06-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CJEM\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s43678-025-00941-2\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CJEM","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s43678-025-00941-2","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
The increased mortality of older patients with moderate traumatic brain injury.
Purpose: Higher mortality has been reported in older patients with moderate traumatic brain Injuries (TBI) compared to younger patients. To identify the risk factors associated with in-hospital mortality, complications and extended length of stay in moderate TBI patients.
Methods: DESIGN: a multicentre observational cohort study using the Quebec Trauma Registry.
Population: Hospitalized patients aged ≥ 16 with a moderate TBI (a head injury with an Abbreviated Injury Scale (AIS) ≥ 3, and a GCS score of 9-12).
Outcomes: In-hospital mortality, complications and prolonged length of stay.
Analyses: Multivariable logistic regression.
Results: We included 1005 patients, 38.1% of whom were aged ≥ 65. The in-hospital mortality rate was 20.1%. Male sex (OR = 1.6 [95% CI:1.02-2.6], age (≥ 85 years old VS < 65 years) (OR = 18.7 [95% CI: 9.2-38.1]), ≥ 2 comorbidities (OR = 2.3 [95% CI: 1.3-4.0]), Injury Severity Score (OR = 1.04 [95% CI: 1.01-1.1]), presence of intraparenchymal hematoma (OR = 3.5 [95% CI: 2.2-5.5]) or other CT scan findings (cerebral edema, pneumocephalus, subpial hemorrhage, and pituitary injury) (OR = 1.9 [95% CI: 1.2-3.1]) were associated with increased odds of mortality. Male sex (OR = 1.8 [95% CI: 1.2-2.6]), age (65-74: OR = 1.7 [95% CI: 1.1-2.8] & 75-84: OR = 1.6 [95% CI: 1.03-2.6]), ≥ 2 comorbidities (OR = 2.9 [95% CI: 1.8-4.7]), thoraco-abdominal concomitant injury (OR = 2.0 [95% CI: 1.01-3.8]), and subarachnoid hemorrhage (OR = 7.6 [95% CI:1.5-38.5]) were associated with increased odds of complications. The number of comorbidities (≥ 2 OR = 1.7 [95% CI: 1.1-2.7]), spine injury (OR = 2.4 [95% CI: 1.4-4.1]), and delirium (OR = 3.1 [95% CI:1.8-5.2]) were associated with an increased odd of extended length of stay.
Conclusions: This study identified risk factors of in-hospital mortality, complications and extended length of stay, most of which are quickly available in the Emergency Department (ED). These factors could help clinicians identify moderate TBI patients at high risk of in-hospital mortality and guide shared decision-making regarding goals of care.
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