Mortality and morbidity predictors in older persons with mild traumatic brain injury: A district-wide study

As the global population of older adults grows, mild traumatic brain injuries (mTBIs) pose an increasing health concern in this demographic. We aim to identify factors influencing mTBI outcomes and to better understand the mortality rates in older patients with mTBIs. We conducted a single-center retrospective analysis of 7,218 patients aged 65 + with mTBI at Soroka University Medical Center (2000-2020). Our study employed a rigorous definition of mTBI (GCS 14-15 only), reflecting institutional protocols and enabling focus on the mildest TBI spectrum. Univariate tests were utilized to compare patients with all-cause mortality within one year following the mTBI and patients who survived beyond the first year of injury. The Kaplan Meir method was used to assess one year survival along with the log-rank test to evaluate survival differences. A COX proportional hazard regression was performed as well to identify potential risk factors for 1- year all-cause mortality. One-year overall mortality rate was 18.7%. Multivariate analysis identified several significant independent predictors of increased mortality, including prior TBI, pathological neuroradiological findings, two or more comorbidities, and chronic use of Novel Oral Anticoagulants (NOACs). In contrast, chronic use of Warfarin and antiplatelet agents was not associated with increased mortality risk. This study sheds light on the complex interplay between clinical factors and outcomes in the mildest spectrum of TBI in older adults. It emphasizes the importance of tailoring treatment plans based on individual risk factors to enhance clinical decision making. Using refined risk stratification criteria has the potential to improve outcomes for older patients with mTBI.