Age, admission platelet count, and mortality in severe isolated traumatic brain injury: A retrospective cohort study

医学 回顾性队列研究 逻辑回归 内科学 队列 损伤严重程度评分 创伤性脑损伤 创伤中心 头部受伤 血小板 儿科 毒物控制 外科 急诊医学 伤害预防 精神科
作者
Thitikan Kunapaisal,Jimmy Phuong,Zhinan Liu,Lynn G. Stansbury,Monica S. Vavilala,Abhijit V. Lele,Hamilton C. Tsang,John R. Hess
出处
期刊:Transfusion [Wiley]
卷期号:63 (8): 1472-1480
标识
DOI:10.1111/trf.17476
摘要

We asked whether patients >50 years of age with acute traumatic brain injury (TBI) present with lower platelet counts and whether lower platelet counts are independently associated with mortality.We combined trauma registry and laboratory data on a retrospective cohort of all patients ≥18 years of age admitted to our Level 1 US regional trauma center 2015-2021 with severe (Head Abbreviated Injury Score [AIS] ≥3), isolated (all other AIS <3) TBI who had a first platelet count within 1 h of arrival. Age and platelet count were assessed continuously and as groups (age 18-50 vs. >50, platelet normals, and at conventional transfusion thresholds). Outcomes such as mean admission platelet counts and in-hospital mortality were assessed categorically and with logistic regression.Of 44,056 patients, 1298 (3%, median age: 52 [IQR 33,68], 76.1% male) met all inclusion criteria with no differences between younger and older age groups for (ISS; 18 [14,26] vs. 17 [14,26], p = .22), New ISS (NISS; 29 [19,50] vs. 28 [17,50], p = .36), or AIS-Head (4 [3,5] vs. 4 [3,5]; p = .87). Patients aged >50 had lower admission platelet counts (219,000 ± 93,000 vs. 242,000 ± 76,000/μL; p < .001) and greater in-hospital mortality (24.5% vs. 15.6%, p < .001) than those 18-50. In multivariable regression, firearms injuries (OR9.08), increasing age (OR1.004), NISS (OR1.007), and AIS-Head (OR1.05), and decreasing admission platelet counts (OR0.998) were independently associated with mortality (p < .001-.041). Platelet transfusion in the first 4 h of care was more frequent among older patients (p < .001).Older patients with TBI had lower admission platelet counts, which were independently associated with greater mortality.
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