Influence of study population definition on the effect of age on outcomes after blunt head trauma.
Matthew E Peters, Michael Hsu, Vani Rao and 9 others
PMID 30230916WHAT IT FOUND
Older adults after blunt head trauma had better 1-month functional recovery and fewer post-concussion symptoms than younger adults, whether or not they met TBI criteria.
Key findings
01Among all blunt head trauma patients, older adults had better 1-month functional recovery, fewer post-concussion symptoms, and fewer depressive symptoms than younger adults, including after adjustment for confounders and head injury severity.
02Even among participants meeting VA/DoD criteria for TBI, older adults had better functional recovery and fewer post-concussion symptoms, while depressive symptoms were similar after adjustment.
03A smaller percentage of older participants met VA/DoD criteria for TBI than younger participants (58% vs 77%).
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study looked only at 1-month outcomes, and people who completed follow-up differed from those who did not. The study was not powered to look at age differences. Age was split at 65 years, but there is no consensus on the critical age threshold at which TBI risk changes. The Extended Glasgow Outcome Scale and PHQ9 are not TBI-specific, and the PHQ9 measured depressive symptoms rather than major depressive disorder. Older participants may have been more likely to come to the emergency department than younger participants, which could leave less symptomatic younger people out of the study. The analysis did not match younger and older participants on key characteristics, and cognition was not assessed.
Declared interests
The authors reported no declarations of interest relevant to this manuscript.
The easy way to misread this
Do not read these results as proof that older age improves recovery after TBI. The study was not powered for age differences, followed patients for only 1 month, and may have included older patients who sought emergency care while younger patients with milder symptoms did not.