title: Age: is it all in the head? Factors influencing mortality in elderly patients with head injuries.
abstract: BACKGROUND
  Elderly patients, an increasing segment of the population, who sustain traumatic brain injury (TBI) are known to have worse outcomes, including higher mortality. This objective of this study was to examine the Crash Injury Research Engineering Network and to determine at what age motor vehicle crash fatalities from head injuries increased.
  
  
  METHODS
  The Crash Injury Research Engineering Network database was queried from 1996 to 2009. Study inclusion criteria were adult vehicle occupants with TBI, with an Abbreviated Injury Scale score ≥2. The age at which mortality increased was calculated. Patients younger and older than this cutoff age were compared to determine differences in crash characteristics. The determined cutoff age was compared with one found in a larger, population-based database.
  
  
  RESULTS
  There were 915 patients who met the study criteria. An increase in mortality was seen at age 60 years despite no difference in Injury Severity Score and a decrease in crash severity. Patients ≤60 years were more likely to have alcohol involved, to be in a rollover crash, and had higher crash speeds. Comparing the element of the crash attributed to the head injury, the patients >60 years were more likely to have struck the airbag, door, and seat. An analysis of the larger database revealed an increase in mortality at age 70 years.
  
  
  CONCLUSIONS
  There was a higher mortality secondary to head injuries in those older than 60 years involved in motor vehicle crashes. Improved safety measures in vehicle design may decrease the number of head injuries seen in the older population.
authors.affiliation: Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, VA, USA. robyn.richmond@inova.org
authors.forename: Robyn
authors.initials: R
authors.lastname: Richmond
authors.forename: Tayseer A
authors.initials: TA
authors.lastname: Aldaghlas
authors.forename: Christine
authors.initials: C
authors.lastname: Burke
authors.forename: Anne G
authors.initials: AG
authors.lastname: Rizzo
authors.forename: Margaret
authors.initials: M
authors.lastname: Griffen
authors.forename: Ranjit
authors.initials: R
authors.lastname: Pullarkat
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death / Q000639:trends; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology