Risk factors associated with moderate and severe traumatic brain injury mortality in admitted older adults: a retrospective, single-center study at a level II trauma center

Purpose: Approximately one in four adults aged ≥65 years experiences a fall each year, and over one-third of these events require medical care. Older adults are at higher risk of complications because of comorbidities. Most prior studies have focused on incidence rather than outcomes, and few have evaluated the association between age and traumatic brain injury (TBI) mortality. This study assessed risk factors and risk-adjusted mortality and morbidity among older adults with moderate or severe TBI. Methods: We conducted a retrospective review of data from a single-center trauma registry. Inclusion criteria were age ≥65 years, admission ≥3 days (2019-2024), Abbreviated Injury Scale (AIS) head region score ≥1, and no documented advance directive limiting care. Patients were stratified by Glasgow Coma Scale (GCS) severity as moderate (GCS 9-12) or severe (GCS <9). Mortality was defined as in-hospital death or discharge to hospice (including transition to comfort care). Morbidity was defined as discharge to a skilled nursing facility or inpatient rehabilitation. Analyses included t-tests or Mann-Whitney U-tests for continuous variables, chi-square tests with odds ratios (ORs) and 95% confidence intervals (CIs) for categorical variables, and logistic regression to identify predictors. Results: Among 199 participants, 92 had moderate and 107 had severe TBI. Advanced airway placement was strongly associated with mortality (OR, 5.7; 95% CI, 2.3-14.4; P<0.001). Higher AIS head region scores predicted morbidity (OR, 1.9; 95% CI, 1.4-2.7; P<0.001). In the moderate TBI cohort, diabetes and advanced airway placement were significant predictors of mortality, and longer length of stay was associated with increased morbidity. In the severe TBI cohort, age and ventilator days predicted mortality, whereas activation level and length of stay predicted morbidity. Conclusions: Predictors of outcomes differed by TBI severity, underscoring the importance of comorbidities, airway management, and hospitalization-related factors in older adults.