Mortality in Moderate to Severe Traumatic Brain Injury in Elderly Polytrauma Patients at a European Level 1 Trauma Centre—A Retrospective Cohort Study

<b><b>Introduction:</b></b> Traumatic brain injury (TBI) remains a significant challenge in older polytrauma patients, with age being a major determinant of outcomes. While mortality predictors have been studied in general polytrauma populations, less is known about specific risk factors in older adults with TBI. <b>Methods:</b> This retrospective study analysed data from 304 polytrauma patients over 18 years of age treated at a Level 1 trauma centre between 2013 and 2023. Patients were divided into three age categories: 18-64 years (<i>n</i> = 189), 65-84 years (<i>n</i> = 92), and ≥85 years (<i>n</i> = 23). The analysis included demographics, injury patterns, clinical indicators, surgical treatments, and in-hospital mortality to identify key mortality predictors. <b>Results:</b> The mean age was 54.5 years (SD 22.2); 72% of patients were male. In-hospital mortality was 36.3% overall, increasing to 60.8% in patients aged ≥85. TBI severity was moderate in 25% and severe in 75% of cases. Older patients were less frequently admitted to the ICU and more often managed conservatively. ICU admission was significantly lower in patients aged 65-84 (24.5%) and ≥85 (19.4%) compared to the 18-64 group (70.0%). Multivariate analysis identified age, male sex, and severe TBI as significant predictors of 30-day mortality. <b>Conclusions:</b> TBI management in older polytrauma patients requires distinct approaches due to higher mortality and poorer outcomes. Age is a critical risk factor, highlighting the need for tailored triage systems and ICU strategies to improve care and prognosis in this vulnerable population.