Objective: Consistent with a rapidly growing geriatric population, the age distribution of traumatic brain injury (TBI) is dramatically changing. The management of elderly TBI patients is a serious problem for neurosurgeons in charge of their treatment in Japan. In this study, we sought to clarify the characteristics of elderly TBI patients transferred to our tertiary critical care center, to better understand the current situation, prognostic factors, and possible therapeutic strategies.
Method: We retrospectively reviewed all TBI patients aged ≥75 years admitted between 2003 and 2012. Demographics, injury mechanism, radiological findings, injury diagnosis, management, and comorbid status information were obtained, as well as outcomes assessed by the Glasgow Outcome Scale at 3 months. Univariate and multivariate analyses were used to identify predictors of mortality and independent living status.
Results: Among 628 consecutive TBI patients, 92 (14.7%) were eligible. The elderly TBI patients had a significantly higher incidence of non-traffic accidents (67.4% vs. 31.5%) and death (27.2% vs.11.6%) compared with those younger than 75 years (p<0.0001). Factors concerning favorable ⁄ unfavorable outcome and alive ⁄ dead were statistically analyzed. In univariate analyses, Glasgow Coma Scale (GCS), GCS motor score, dilated pupils, surgical intervention, serum d-dimer level, prothrombin time-international normalized ratio, injury severity score, and head abbreviated injury score (AIS) were significant in both outcome evaluations. Sex, acute subdural hematoma, and “talk and deteriorate” clinical course correlated with favorable ⁄ unfavorable outcome; heart rate, subarachnoid hemorrhage, and cranial vault fracture correlated with alive ⁄ dead. Multivariate analysis revealed significance in the mechanism of injury, GCS, head AIS, and “talk and deteriorate” clinical course for favorable ⁄ unfavorable outcome; heart rate and subarachnoid hemorrhage were significant for alive ⁄ dead.
Conclusion: Our study confirmed poor outcome and treatment difficulties in TBI patients aged 75 years and older. Multi-disciplinary collaboration is warranted to mitigate comorbidities and functional deterioration in the elderly.