With the rapid expansion of the elderly population, there has been an increase in the number of elderly traumatic brain injury (TBI) patients in Japan. Despite the recent progress in the treatment and monitoring of TBI patients, the prognosis of geriatric TBI remains unfavorable.
In this study, differences in treatment and outcome between young and elderly TBI patients were compared in the Japan Neurotrauma Data Bank Project 2004 (JNTDB P2004).
Methods: Of 1101 cases registered in the JNTDB P2004, cases of cardiopulmonary arrest on arrival and pediatric patients (< 16 y.o) were excluded, and 952 cases were enrolled in this study. These cases were divided into two groups, the non-elderly group (Group N: 16 – 64 y.o) and the elderly group (Group E: over 65 y.o).
The clinical features, treatment and outcomes of the two groups were compared. To clarify the reasons for aggressive treatment of geriatric TBI cases, logistic regression analysis was performed in Group E.
Results: Initial Glasgow Coma Scale (GCS), worst GCS (< 48 hours after injury), pulse rate, and initial body temperature did not differ significantly between the two groups. Injury Severity Score (ISS) and respiratory rate on admission were significantly lower in Group E. On the other hand, systemic blood pressure and the pH of the arterial blood gas on admission were significantly higher in Group E.
Based on the Glasgow Outcome Scale at discharge, the ratio of good outcome (good recovery and moderate disability) was significantly lower in Group E.
With the analysis of Group E, age, initial GCS and worst GCS were correlated with the decision for aggressive treatment. In particular, initial GCS was most correlated with the determination for aggressive treatment.
Our result revealed differences in the pathophysiological features between young and elderly TBI patients. We also found that the initial GCS was the most correlative factor for determination of aggressive treatment in geriatric TBI patients. Further examination of prognostic factors will be needed in elderly TBI patients, and specific guidelines for geriatric head injuries should be established.
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