Clinical Characteristics and Outcome in Elderly Patients with Traumatic Brain Injury: For Establishment of Management Strategy

Abstract

In recent years, instances of neurotrauma in the elderly have been increasing. This article addresses the clinical characteristics, management strategy, and outcome in elderly patients with traumatic brain injury (TBI). Falls to the ground either from standing or from heights are the most common causes of TBI in the elderly, since both motor and physiological functions are degraded in the elderly. Subdural, contusional and intracerebral hematomas are more common in the elderly than the young as the acute traumatic intracranial lesion. High frequency of those lesions has been proposed to be associated with increased volume of the subdural space resulting from the atrophy of the brain in the elderly. The delayed aggravation of intracranial hematomas has been also explained by such anatomical and physiological changes present in the elderly. Delayed hyperemia/hyperperfusion may also be a characteristic of the elderly TBI, although its mechanisms are not fully understood. In addition, widely used pre-injury anticoagulant and antiplatelet therapies may be associated with delayed aggravation, making the management difficult for elderly TBI. It is an urgent issue to establish preventions and treatments for elderly TBI, since its outcome has been remained poor for more than 40 years.

The Increasing Age of TBI Patients at a Single Level 1 Trauma Center and the Discordance Between GCS and CT Rotterdam Scores in the Elderly

“…The major contributing factor to the changing incidence of TBI mechanisms is related to the growing elderly population. Falls are the most common mechanism of injury in the elderly secondary to the effects of age on physical function (5,6). It is estimated that between 45 and 78% of geriatric patients are frail at the time of injury and this frailty has been associated with a 50% increase in mortality (7)(8)(9)(10).…”

“…Differences in outcomes after TBI are associated with age, with outcomes worsening as early as age 45 (6,13). While the incidence of TBI in the younger population has remained relatively unchanged, the incidence of TBI is increasing in the elderly population (10,14,15).…”

“…In addition, while patients 65 years and older only account for 15% of the population, they make up 50% of TBI-related deaths (10,12) and patients older than 75-years old experience twice the rate of TBI (10). This leads to increased resource utilization due to longer hospital stays and more frequent follow-up (6,10,13). In addition, acute measurements of injury severity, such as the Glasgow Coma Scale (GCS), may not be reliable predictors of morbidity and mortality in patients over the age of 45 (10).…”

Atmospheric impregnation behavior of calcium phosphate materials for antibiotic therapy in neurotrauma surgery

“…The prognosis of patients treated for traumatic brain injury is strongly dependent on prehospital care, maintenance of emergency systems, and rapid response to secondary injuries such as blood flow and metabolic abnormalities [1,2]. In particular, open depressed cranial fractures require surgery within 24 h after onset, and the risk of infection clearly increases after 48 h [3].…”

The effect of milrinone on mortality in adult patients: A systematic review of randomized clinical trials with meta-analysis and trial sequential analysis

“…8,[18][19][20][21] To minimize the occurrence of postoperative complications, pre-and/or postoperative medicinal applications, such as phosphodiesterase (PDE) III inhibitors, have been primary strategies until now. [22][23][24] By reducing the inactivation of cyclic adenosine phosphate (cAMP) in cardiomyocytes, PDE III inhibitors enhance myocardial contractility and produce positive inotropic effects; 25,26 a higher concentration of cAMP results in contractility, increasing myocardial tissue and the vasodilatory effect on vascular smooth muscle. 27,28 Milrinone, one of the PDE III inhibitors, primarily used after openheart surgery because it can avoid cardiopulmonary bypass, 29 enhances cardiac contractility, 30 prevents vasospasm, 31 and ameliorates low output syndrome (LOS).…”