高齢者重症頭部外傷の臨床的特徴と積極的加療における転帰について

抄録

Age may be an independent predictor of outcome in traumatic brain injury (TBI). However, predictors of positive outcomes in the elderly remain unclear. The purpose of this study was to assess our current treatment for severe TBI in elderly patients, and to examine the problem. Between April 2006 and September 2011, 108 patients with severe TBI were enrolled. Of these, 44 patients over 65 years of age were classified into the Elderly group (E group) and the remaining 64 patients under 64 years of age were classified into the Non-Elderly group (N-E group). Age, sex, cause of TBI, Glasgow coma scale (GCS), injury severity, the existence of talk and deteriorate (T&D), the existence of pupil abnormalities, and the kind of TBI were compared between groups. As for the cause of TBI, pedestrian traffic accidents and accidental falls accounted for three-quarters of all patients in the E group. With respect to treatment, there was no significant difference in terms of frequency of craniotomy between the E group and the N-E group. Intracranial pressure (ICP) monitoring was enforced more often in the E group. As a result, poor outcome remains significantly higher in the E group. However, the mortality rate for patients with T&D was significantly lower than in patients without T&D in the E group (p=0.0037). In today's aging society, medical decisions should not be made on the basis of age. The pathophysiology and severity of TBI should be considered in order to determine the possibility of lifesaving.