David E. Clark, MD¹, Michael A. DeLorenzo, PhD¹, Katherine L. Anderson¹, and Joseph T. Donohue, MD². (1) Center for Outcomes Research and Evaluation, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, 207-774-2381, clarkd@mmc.org, (2) Department of Surgery, Maine Medical Center, 22 Bramhall St, Portland, ME 04102

Purpose: We sought to determine long-term survival in older patients hospitalized with head injury.

Methods: Fee-for-service patients age 65 or older admitted for the first time with head injury (ICD-9 800-804 or 850-854) during 1999 were identified in a complete national sample of Medicare hospitalization and denominator data. Cases were categorized by age, sex, maximum Abbreviated Injury Score (AISmax), and Charlson comorbidity score. Survival was determined at hospital discharge, and (using the denominator file) at 1 month, 6 months, 12 months, and 24 months after the initial hospital admission.

Results: For all cases (n=30,684), the hospital mortality was 14.3%, but was cumulatively 19.7%, 30.5%, 36.1%, and 44.9% at successive times up to 24 months. Mortality was higher with increased age or comorbidity score. For patients with AISmax of 1 (minimal), the hospital mortality was only 1.9%, but mortality at 24 months was 37.6%. For patients with AISmax of 5 (severe), the hospital mortality was 76% and mortality at 24 months was 93.1%.

Conclusions: Head injury in older patients is associated with very high mortality, which continues to rise after hospital discharge. Late mortality is only partially explained by injury severity. Awareness of the expected prognosis may be useful in clinical decisions during acute hospitalization. These findings illustrate the importance of preventive measures, as well as their limitations.

Learning Objectives:

• Persons reviewing this poster will understand the expected long-term survival of older patients hospitalized with head injury diagnoses, and the effects on survival of injury severity, comorbidity, age, and sex.

Keywords: Elderly, Traumatic Brain Injury

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.