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Objective:
To determine clinical and radiological factors on admission affecting mortality in patients with traumatic brain injury aged 80 years or more
Design:
Retrospective analysis of data extracted from institutional trauma registry and chart review from 2002 to 2012
Setting:
Tertiary care medical center with full neurosurgical coverage and ICU capabilities
Patients:
551 patients 80 years and older admitted with traumatic brain injury (TBI) identified in our trauma registry using ICD-9 coding (800-804, 850-854).
Interventions:
None
Main outcome measures:
Mortality occurring during initial hospitalization.
Results:
Overall mortality in our cohort of TBI patients was 12.5%. We examined clinical factors associated with mortality and sought to extend this by adding radiological findings on initial CT scans in an attempt to improve our ability to identify non-survivors.

CLINICAL FACTORS	MORTALITY	p value
Anisocoria present	50.0%	<0.005
Anisocoria absent	10.5%
Fixed pupil present	78.1%	<0.005
Fixed pupil absent	8.4%
GCS<13 in non-intubated	40.0%	<0.005
GCS≥13 in non-intubated	5.1%
Intubated	65.0%	<0.005
Not intubated	7.1%
RADIOLOGICAL FACTORS	MORTALITY	p value
SDH present	14.6%	<0.01
SDH absent	7.3%
Midline Shift present	25.8%	<0.05
Midline Shift absent	7.3%

Anisocoria, fixed pupils, GCS less than 13 in non-intubated patients, intubation, and the presence of SDH or midline shift were associated with increased mortality. Anticoagulation was not a significant risk factor for mortality.
Conclusion:
We have identified clinical and radiological factors on admission associated increased mortality in head injury patients 80 years or older. This can aid in directing treatment
goals and differentiating patients who will benefit from aggressive treatment from patients who will not.