高齢者頭部外傷における特徴と予後規定因子の検討

抄録

Background: The aging of the Japanese population is accompanied by a rapid rise in the number of elderly head trauma patients. The characteristics of elderly patients differ from those of young patients and must be thoroughly understood if appropriate treatment strategies are to be developed. In this study we examined the characteristics of elderly head trauma patients in our institution and clarified the factors that influ­ence their prognosis.

Methods: Nine hundred and eighty–two head trauma patients admitted to Tokyo Medical and Dental University Hospital from 2015 to 2021 were enrolled in the study. The patients were divided into two groups: an elderly group aged 75 years or older (group E) and a non–elderly group aged less than 75 years (group Y). We retrospectively examined the correlations between clinical parameters such as patient background, type of injury, neurological symptoms, head CT findings, post–hospital course, and clinical outcome.

Results: Of the total 982 cases, 200 (20.4%) were in group E. Compared with the younger patients, group E was made up of a higher proportion of males (59.0% vs 80.2%: p<0.01) and a higher proportion of patients taking antithrombotic drugs (28.0% vs 4.3%: p<0.01). Acute subdural hematoma was sig­nificantly more frequent in group E (58.5% vs 30.9%: p<0.01). Talk and Deteriorate and surgical intervention were not sig­nificantly different between the two groups. Group E patients had more infections during hospitalization (29.5% vs 12.5%: p<0.01), more psychiatric symptoms (22.0% vs 9.3%: p< 0.01), a significantly higher rate of poor outcome (44.0% vs 18.9%: p<0.01), and a significantly longer median hospital stay (8 days vs 5 days: p<0.01). The Glasgow Coma Scale at administration and acute subdural hematoma were risk factors for poor outcome, and Talk and Deteriorate, surgical interven­tion, and infection were risk factors for an extended hospital stay.

Conclusion: Acute subdural hematoma was common in the elderly patients and was a significant factor of poor clinical outcome. Infection prevention might be the most important target in elderly patients, as infections are associated with poor clinical outcome and prolonged hospitalization.