Analysis and problems of severe traumatic brain injury in the aging area

Abstract

Background: Severe traumatic brain injury is the most common cause of traumatic death. The average age of the population of Japan is increasing and according to the Japan Neurotrauma Data Bank, the number of older patients with severe traumatic brain injuries is also increasing.

Materials and Methods: Awaji Island is home to approximately 130,000 individuals who are, on average, older than residents of other regions in Japan, with approximately 35% of the population considered elderly. Hyogo Prefectural Awaji Medical Center, a major hospital on Awaji Island, treats almost all patients with severe traumatic brain injury on the island. We retrospectively examined the ages, mechanisms of injury, blood test results, surgical procedures, hospitalization complications, and prognoses in 72 patients with severe traumatic brain injuries who were treated at our hospital from 2014 to 2018.

Results: Compared with those in the Japan Neurotrauma Data Bank cohort, the ratios of age to fall injuries were significantly higher in our cohort (p=0.029, p=0.014). The age distribution of our cohort featured a single peak in the eighth decade of life. During multivariate analysis of factors related to favorable prognosis, low D–dimer and age were significant prognostic factors (p=0.033, p=0.045). In elderly people older than 75 years, the prognoses were mostly poor; however, a good prognosis was observed in six cases (16.7%). Prompt treatment was administered in these cases and relatively minor injuries were observed. Seven elderly individuals (19.4％) fell on the job or were involved in a motor vehicle accident; these individuals exhibited a poor prognosis.

Conclusion: Our study revealed a higher number of elderly individuals with severe traumatic brain injuries compared to that in a recent study. As with the previous study, elderly patients in our study exhibited a poor prognosis. However, since some elderly patients had a good prognosis, immediate treatment was considered particularly important and potentially life–saving. Additionally, elderly individuals with severe head injuries were more likely to have sustained falls to the ground, and falls on the job and injuries while driving were also observed. Since severe injuries generally relate to poor prognosis, preventative medical and administrative measures should be the focus.