Research Reports - Promising clinical outcome of elderly with TBI after modern neurointensive care

Acta Neurochir (Wien). 2016 Jan;158(1):125-33. doi: 10.1007/s00701-015-2639-6.
Epub 2015 Nov 18.

Merzo A(1), Lenell S(1), Nyholm L(1), Enblad P(1), Lewén A(2).

BACKGROUND: The increasing number of elderly patients with traumatic brain injury
(TBI) leads to specific neurointensive care (NIC) challenges. Therefore, elderly
subjects with TBI need to be further studied. In this study we evaluated the
demographics, management and outcome of elderly TBI patients receiving modern
NIC.
METHODS: Patients referred to our NIC unit between 2008 and 2010 were included.
Patients were divided in two age groups, elderly (E) ≥65 years and younger (Y)
64-15 years. Parameters studied were the dominant finding on CT scans,
neurological motor skills and consciousness, type of monitoring, neurosurgical
procedures/treatments and Glasgow Outcome Scale Extended score at 6 months after
injury.
RESULTS: Sixty-two E (22 %) and 222 Y (78 %) patients were included. Falls were
more common in E (81 %) and vehicle accidents were more common in Y patients
(37 %). Acute subdural hematoma was significantly more common in E (50 % of
cases) compared to Y patients (18 %). Intracranial pressure was monitored in 44 %
of E and 57 % of Y patients. Evacuation of significant mass lesions was performed
more common in the E group. The NIC mortality was similar in both groups (4-6 %).
Favorable outcome was observed in 72 % of Y and 51 % of E patients. At the time
of follow-up 25 % of E and 7 % of Y patients had died.
CONCLUSIONS: The outcome of elderly patients with TBI was significantly worse
than in younger patients, as expected. However, as much as 51 % of the elderly
patients showed a favorable outcome after NIC. We believe that these results
encourage modern NIC in elderly patients with TBI. We need to study how secondary
brain injury mechanisms differ in the older patients and to identify specific
outcome predictors for elderly patients with TBI. 

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