Higher age is a major driver of in-hospital adverse events independent of comorbid diseases among patients with isolated mild traumatic brain injury

  • Barbara R. Schmidt
  • Rudolf M. Moos
  • Dilek Könü-Leblebicioglu
  • Heike A. Bischoff-Ferrari
  • Hans-Peter Simmen
  • Hans-Christoph Pape
  • Valentin NeuhausEmail author
Original Article



The goal of this study was to investigate if and to what extent age, independent of comorbid diseases, is a risk factor for negative in-hospital outcome with mTBI.


In a retrospective cohort study, we identified 1589 adult patients treated for isolated mTBI in our level-1 trauma center between 2008 and 2015. We used logistic regression analyses to assess the odds of any adverse event by age group (< 65, 65–75, 76–85, and 85+), adjusting for gender and chronic diseases.


The prevalence of any adverse event during in-hospital care among mTBI patients was 3.2% overall, 1.8% among those younger than age 65 years, 2.1% among those age 65–75 years, 8% among those age 75–85 years, and 19% among those age 85+ years. The odds of any adverse event were similar in patients aged 65–75 years, but increased among senior patients 4.4-fold for age 75–85 years (OR 4.4, 95%CI 2.0–9.8, p < 0.001), and 18-fold for age 85+ years (OR 18.0, 95%CI 8.7–37, p < 0.001). Additionally, chronic alcohol abuse (OR 7.0, 95%CI 3.2–15, p < 0.001), diseases of the musculoskeletal system (OR 4.3, 95%CI 1.5–13, p = 0.008), and diabetes mellitus (OR 2.7, 95%CI 1.2–6.5, p = 0.023) increased the odds of any adverse events independent of age and all other covariates.


The odds of sustaining an adverse event increased exponentially after age 75 independent of gender and any comorbid diseases. Our data support international efforts to manage senior patients in interdisciplinary geriatric trauma units.


Adverse events Minor traumatic brain injury Risk factors Senior patients 


Compliance with ethical standards

Conflict of interest

There are no conflicts of interest with this topic.


  1. 1.
    Corrigan JD, Selassie AW, Orman JA. The epidemiology of traumatic brain injury. J Head Trauma Rehabil. 2010;25(2):72–80. Scholar
  2. 2.
    Mortality GBD, Causes of Death C. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117–71. Scholar
  3. 3.
    Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges ahead. Lancet. 2009;374(9696):1196–208. Scholar
  4. 4.
    Salomon JA, Wang H, Freeman MK, Vos T, Flaxman AD, Lopez AD, et al. Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet. 2012;380(9859):2144–62. Scholar
  5. 5.
    Maegele M, Schochl H, Menovsky T, Marechal H, Marklund N, Buki A, et al. Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management. Lancet Neurol. 2017;16(8):630–47. Scholar
  6. 6.
    Epstein DS, Mitra B, Cameron PA, Fitzgerald M, Rosenfeld JV. Acute traumatic coagulopathy in the setting of isolated traumatic brain injury: definition, incidence and outcomes. Br J Neurosurg. 2014:1–5.
  7. 7.
    Fabbri A, Servadei F, Marchesini G, Bronzoni C, Montesi D, Arietta L, et al. Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study. Crit Care. 2013;17(2):R53. Scholar
  8. 8.
    Carroll LJ, Cassidy JD, Peloso PM, Borg J, von Holst H, Holm L, et al. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004(43 Suppl):84–105.Google Scholar
  9. 9.
    Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien). 1976;34(1–4):45–55.CrossRefGoogle Scholar
  10. 10.
    Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The glasgow coma scale at 40 years: standing the test of time. Lancet Neurol. 2014;13(8):844–54. Scholar
  11. 11.
    Yates D, Aktar R, Hill J, Guideline Development G. Assessment, investigation, and early management of head injury: summary of NICE guidance. BMJ. 2007;335(7622):719–20. Scholar
  12. 12.
    Foks KA, Cnossen MC, Dippel DWJ, Maas A, Menon D, van der Naalt J, et al. Management of mild traumatic brain injury at the emergency department and hospital admission in Europe: a survey of 71 neurotrauma centers participating in the CENTER-TBI study. J Neurotrauma. 2017. Scholar
  13. 13.
    Bruns J Jr, Hauser WA. The epidemiology of traumatic brain injury: a review. Epilepsia. 2003;44(Suppl 10):2–10.CrossRefGoogle Scholar
  14. 14.
    Faul M, Coronado V. Epidemiology of traumatic brain injury. Handb Clin Neurol. 2015;127:3–13. Scholar
  15. 15.
    Dams-O’Connor K, Cuthbert JP, Whyte J, Corrigan JD, Faul M, Harrison-Felix C. Traumatic brain injury among older adults at level I and II trauma centers. J Neurotrauma. 2013;30(24):2001–13. Scholar
  16. 16.
    Salottolo K, Levy AS, Slone DS, Mains CW, Bar-Or D. The effect of age on Glasgow Coma Scale score in patients with traumatic brain injury. JAMA Surg. 2014;149(7):727–34. Scholar
  17. 17.
    Demetriades D, Kuncir E, Murray J, Velmahos GC, Rhee P, Chan L. Mortality prediction of head Abbreviated Injury Score and Glasgow Coma Scale: analysis of 7,764 head injuries. J Am Coll Surg. 2004;199(2):216–22. Scholar
  18. 18.
    Susman M, DiRusso SM, Sullivan T, Risucci D, Nealon P, Cuff S, et al. Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma. 2002;53(2):219–23 (discussion 23–4).CrossRefGoogle Scholar
  19. 19.
    Mosenthal AC, Livingston DH, Lavery RF, Knudson MM, Lee S, Morabito D, et al. The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial. J Trauma. 2004;56(5):1042–8.CrossRefGoogle Scholar
  20. 20.
    Czosnyka M, Balestreri M, Steiner L, Smielewski P, Hutchinson PJ, Matta B, et al. Age, intracranial pressure, autoregulation, and outcome after brain trauma. J Neurosurg. 2005;102(3):450–4. Scholar
  21. 21.
    WHO. International Classification of Diseases. 2016.Google Scholar
  22. 22.
    Statistik Bf. Schweizerische Operationsklassifikation (CHOP): systematisches Verzeichnis, Version 2017. Bundesamt für Statistik. 2017.Google Scholar
  23. 23.
    Nguyen R, Fiest KM, McChesney J, Kwon CS, Jette N, Frolkis AD, et al. The International Incidence of Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Can J Neurol Sci. 2016;43(6):774–85. Scholar
  24. 24.
    Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–34. Scholar
  25. 25.
    Strandberg T, Pitkala K, Tilvis R. Benefits of optimising drug treatment in home-dwelling elderly patients with coronary artery disease. Drugs Aging. 2003;20(8):585–95.CrossRefGoogle Scholar
  26. 26.
    Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ. 1997;315(7115):1096–9.CrossRefGoogle Scholar
  27. 27.
    Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9):1107–16.CrossRefGoogle Scholar
  28. 28.
    Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med. 2001;38(6):666–71. Scholar
  29. 29.
    Pentland B, Hutton LS, Jones PA. Late mortality after head injury. J Neurol Neurosurg Psychiatry. 2005;76(3):395–400. Scholar
  30. 30.
    Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324(6):370–6. Scholar
  31. 31.
    Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22. Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Trauma Surgery, Department of Surgery, University Hospital ZurichUniversity of ZurichZurichSwitzerland
  2. 2.Medical DirectorateUniversity Hospital ZurichZurichSwitzerland
  3. 3.Department of Neurosurgery, University Hospital ZurichUniversity of ZurichZurichSwitzerland
  4. 4.Department of Geriatrics, University Hospital ZurichUniversity of ZurichZurichSwitzerland

Personalised recommendations