Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care

Abstract

Background The probability of favorable outcome after traumatic brain injury (TBI) decreases with age. Elderly, ≥ 60 years, are an increasing part of our population. Recent studies have shown an increase of favorable outcome in elderly over time. However, the optimal patient selection and neurointensive care (NIC) treatments may differ in the elderly and the young. The aims of this study were to examine outcome in a larger group of elderly TBI patients receiving NIC and to identify demographic and treatment related prognostic factors. Methods Patients with TBI ≥ 60 years receiving NIC at our department between 2008 and 2014 were included. Demographics, co-morbidity, admission characteristics, and type of treatments were collected. Clinical outcome at around 6 months was assessed. Potential prognostic factors were included in univariate and multivariate regression analysis with favorable outcome as dependent variable. Results Two hundred twenty patients with mean age 70 years (median 69; range 60–87) were studied. Overall, favorable outcome was 46% (Extended Glasgow Outcome Scale (GOSE) 5–8), unfavorable outcome 27% (GOSE 2–4), and mortality 27% (GOSE 1). Significant independent negative prognostic variables were high age ( p < 0.05), multiple injuries ( p < 0.05), GCS M ≤ 3 on admission ( p < 0.05), and mechanical ventilation ( p < 0.001). Conclusions Overall, the elderly TBI patients > 60 years receiving modern NIC in this study had a fair chance of favorable outcome without large risks for severe deficits and vegetative state, also in patients over 75 years of age. High age, multiple injuries, GCS M ≤ 3 on admission, and mechanical ventilation proved to be independent negative prognostic factors. The results underline that a selected group of elderly with TBI should have access to NIC.

Pre-injury antithrombotic agents predict intracranial hemorrhagic progression, but not worse clinical outcome in severe traumatic brain injury

“…Vitamin K antagonists are associated with increased mortality and unfavorable clinical outcome in many TBI studies [4,11,14,28,29,36], but we and others have found no such associations [18,22]. In the current study, anticoagulants were associated with a higher mortality and a decreased rate of favorable clinical outcome in the univariate analysis, but not after adjustment for age, comorbidities, and mechanism of injury.…”

“…The epidemiology of traumatic brain injury (TBI) is changing. As the population ages, the incidence of old TBI victims with pre-injury comorbidities has increased [ 18 , 19 , 31 , 32 ]. This implicates new challenges in TBI care, and one particular concern is the pre-injury use of antithrombotic agents.…”

Characteristics of traumatic brain injury patients with abnormal neuroimaging in Southeast Norway

“…Patients with a pre-injury ASA-PS score of ≥ 3 were substantial (28%) compared to CENTER-TBI which was 11% (Steyerberg et al 2019); the latter is similar to the general trauma population admitted to OUH (10%) (Sovik et al 2014). The more silent comorbidity; antithrombotics, were used by 42% of our TBI patients > 50 years and this compares to other TBI studies, 33-47%, on the elderly population (Gaist et al 2017;Julien et al 2017;Narum et al 2016;Lenell et al 2019). In the total Norwegian population 18% ≥ 40 years use antithrombotic drugs (Berg et al 2017) in line with previously mentioned EU study (Steyerberg et al 2019).…”

“…Controversy exists if old patients benefit from aggressive treatment. However, research has demonstrated improved outcome with aggressive treatment in elderly (Herou et al 2015 ; Lenell et al 2019 ; Bus et al 2019 ; Whitmore et al 2012 ). It is worth noting that although pre-injury comorbidity was high in older age groups, about 60% of patients 80–89 years still lived independently at home (Fig.…”

Identification of prognostic factors in surgically treated patients with acute epidural hematoma

“…However, in the present study, the GCS score was the second independent factor of good prognosis of AEDH, and a GCS score of 12 was the optimal cutoff value to reflect patient prognosis, as reported in previous studies on ASDH and TBI. [ 2 10 14 15 16 17 18 19 ] Indeed, functional brain damage could be reflected by neurological evaluation, not by radiographical findings, and a GCS score of 12 could be the threshold to indicate whether the brain damage is irreversible.…”