TITLE:
Prognostic Factors to Reduce ICU Overtriage in Elderly Patients with Isolated Mild Traumatic Brain Injury
AUTHORS:
Tomas Jacome, Chris LaBorde, Richard Lewis, Danielle Tatum
KEYWORDS:
Traumatic Brain Injury, Geriatric Trauma, Overtriage, Intensive Care Unit, Outcomes
JOURNAL NAME:
Surgical Science,
Vol.14 No.7,
July
25,
2023
ABSTRACT: Introduction: Elderly patients with mild traumatic brain injury
(mTBI) are frequently admitted to an intensive care unit (ICU), which is
potentially both harmful and unnecessary. It is not known which patients may be
safely observed in a non-ICU setting, potentially improving ICU utilization.
The purpose of this study was to identify factors that predict which geriatric
patients with traumatic brain injury may be admitted to a level of care other than
the ICU. Methods: Adults ≥65+ years admitted with positive radiologic study
demonstrating isolated mTBI (defined as Glasgow Coma Scale (GCS) 13 - 15) that was initially
managed nonoperatively between January 2011-December 2016 were identified. Primary outcomes
evaluated included over triage and Glasgow Outcome Scale (GOS). Results: 207 were identified. Most patients presented with
GCS 15 (77.8%) and were admitted to ICU (85.5%). 27% (n = 55) met overtriage
criteria. The most common TBI was subdural hemorrhage (SDH) (48.8%) followed by
subarachnoid hemorrhage (SAH) (22.2%). Hemorrhage progression developed in 8.7%
of subjects, but there was no difference across TBI type. 21.7% of patients
developed a ≥2 point decrease in GCS during their hospital stay. Upon
discharge, 89.9% had a GOS ≥ 4 - 5. Presence/type of a
single intracranial hemorrhage (ICH) was not significantly associated with
outcome, but presence of bilateral or multiple lesions was significantly
associated with poor outcome (p = 0.04). Conclusions: Overtriage of
patients to an ICU is costly, resource intensive, and avoidable. Here, we
suggest a conservative framework to assist the determination of which patients
can be safely observed in non-ICU setting. Future studies should determine if
this framework is generalizable to the entire geriatric population who present
with mTBI.