White Matter Disease Correlates With Age and Intensive Care Outcomes in Moderate-to-Severe TBI

Sunday, March 22, 2026

2:30 PM - 3:30 PM Central Time

Location: Connections Central - RST 06

Miranda Saathoff, BS (she/her/hers)

California

Disclosure(s): No relevant financial relationship(s) to disclose.
MP

Maria Paulino, BS

Medical Student
University of California, Irvine School of Medicine

Disclosure information not submitted.
AF

Amanda Fang, n/a

Undergraduate Student
University of California, Irvine

Disclosure information not submitted.
BJ

Brian Jung, MD

Assistant Clinical Professor
University of California, Irvine Medical Center

Disclosure information not submitted.
SS

Sara Stern-Nezer, MD, MPH

Associate HS Professor
University of California, Irvine Medical Center

Disclosure information not submitted.
YA

Yama Akbari, MD, PhD

Associate Professor
University of California, Irvine Medical Center

Disclosure information not submitted.
WY

Wengui Yu, MD, PhD

Professor of Clinical Neurology
University of California, Irvine Medical Center

Disclosure information not submitted.
IK

Imad Khan, MD

Associate Professor of Clinical Neurology
University of California, Irvine Medical Center

Disclosure information not submitted.
CD

Cyrus Dastur, MD

HS Associate Clinical Professor
University of California, Irvine Medical Center

Disclosure information not submitted.
AR

Ahmad Riad Ramadan, MD

Associate Clinical Professor
University of California, Irvine Medical Center

Disclosure information not submitted.
SM

Sean McDougall, MD

Assistant Professor
University of California, Irvine Medical Center

Disclosure information not submitted.
MG

Michelle Goodwin, MD

Neurocritical Care Fellow
University of California, Irvine Medical Center

Disclosure information not submitted.
DW

Dylan Warfield, MD

Neurocritical Care Fellow
University of California, Irvine Medical Center

Disclosure information not submitted.
JC

Jefferson Chen, MD, PhD

Health Sciences Clinical Professor
University of California, Irvine Medical Center

Disclosure information not submitted.
AG

Areg Grigorian, MD

Assistant Professor of Surgery - Trauma, Critical Care, and Burn
University of California, Irvine Medical Center

Disclosure information not submitted.
JN

Jeffry Nahmias, MD

Assistant Professor of Surgery - Trauma, Critical Care, and Burn
University of California, Irvine Medical Center

Disclosure information not submitted.
PC

Patrick Chen, MD

Health Sciences Assistant Clinical Professor
University of California, Irvine Medical Center

Disclosure information not submitted.

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.