Introduction: With an aging US population, geriatric (≥65yo) traumatic brain injuries (TBIs) are increasingly prevalent. Studies suggest white matter disease (WMD), as measured by brain magnetic resonance imaging (MRI), is common in older adults and can be a radiographic marker of brain age and cognitive resilience. The prognostic role of WMD in moderate-severe TBI (msTBI) is unknown. We aimed to determine if WMD on MRI predicts discharge outcomes as measured by the modified Rankin scale (mRS). Methods: A single Level-I trauma center retrospective cohort study (9/2022-5/2025) was performed including all neurocritical care consults (N=161) for msTBI (consult criteria: GCS< 13, invasive neuromonitoring, and/or complex TBI per SICU). Comparisons were made between geriatric and non-geriatric with a primary outcome of mRS≥5 at discharge (poor outcome). Secondary outcomes were length of stay (LOS), neurosurgery, discharge GCS, and tracheostomy/gastrotomy placement. WMD burden measured using Fazekas scale (0-3 graded scale). Fazekas scores extracted from MRI data (N=98). Predicted probabilities were derived from logistic regression models adjusting for age, sex, and GCS. Results: Geriatric patients had more cardiovascular disease (CVD; 55.8% vs. 9.3%, p< 0.001) and more poor outcomes (65.1% vs. 28.8%, p< 0.001) but similar rates of neurosurgery (60.5% vs. 55.1%, p=0.125), compared to non-geriatric. Fazekas score of 3 was associated with higher age (71.3 vs. 32.2, p< 0.001) and rates of CVD (75% vs. 9.8%, p=0.008) and worse discharge mRS (4.3 vs. 3.1, p=0.004) and GCS (12.5±4.4 vs. 12.7±3.0, p=0.050); but there were no differences in LOS (39.6±44 vs. 17±5.4, p=0.125) or rates of tracheostomy/gastrotomy (25% vs. 43.9%, p=0.763). Higher Fazekas scores trended toward greater probability of poor outcome (OR=4.04, CI=0.51-42.1, p=0.2). Exploratory Spearman’s correlation found a positive association between Fazekas score and discharge mRS (rs=0.35, p< 0.001) as well as Fazekas score and age (rs=0.63, p< 0.001) when adjusted for sex and race. Conclusions: In this cohort, geriatric patients had worse acute outcomes compared to non-geriatric. WMD burden correlated with both age and mRS. This study suggests Fazekas score may serve as a proxy for biological age with potential utility in prognosis of geriatric msTBI.
Saathoff et al. (Sun,) studied this question.