Increased Mortality Associated with Cerebral Contusions following Trauma in the Elderly: Bad Patients or Bad Management?

Abstract

Age has been identified as an independent risk factor for poor outcome following head injury in the elderly, and postulated reasons for this include nature, nurture, and variations in management. Do elderly head injuries do worse because of a self-fulfilling prophecy of poorer management? The aim of this study was to review the management of patients with cerebral contusions according to age to identify any trends. We retrospectively reviewed prospectively collected national data on cerebral contusion admissions between March 14, 1988, and May 4, 2012, to UK hospitals held in the Trauma Audit and Research Network database. Patients were included in the study if they had cerebral contusion(s) with an abbreviated injury score (AIS) of 3 or more; no other head injury with a AIS score of 4 or more, or no injury in any other body region with AIS score of 3 or more, and known outcome data. In total, 4387 patients met the inclusion criteria. Mortality was found to increase with increasing age (p<0.001). However, time from admission to CT head imaging (p=0.003) and the likelihood of not being transferred to a center with acute neurosurgical care facilities (p<0.001) increased with increasing age, too. Further, there was a significant trend for the most senior grade of doctor to review more younger patients and for only the most junior grade of doctor to review more older patients (both, p<0.001). To conclude, our data suggest differences in management practice may contribute to the observed differences in mortality between younger and older patients suffering brain contusions.

Presença da família durante o atendimento emergencial: percepção do paciente vítima de trauma

“…O aumento no número de indivíduos atendidos por traumas decorrentes de causas externas tem se caracterizado como um grave e atual desafio para a saúde pública mundial, com forte impacto na elevação dos índices de morbimortalidade na população economicamente ativa (1)(2). No Brasil, em 2012, por exemplo, quase um milhão de pessoas foram hospitalizadas por causas externas no Sistema Único de Saúde, das quais mais de 152 mil evoluíram para o óbito; aproximadamente 53% das hospitalizações e 77% das mortes ocorreram em pessoas com idade entre 15 e 59 anos (3).…”

“…Por ser um acontecimento indesejável e imprevisto, é vivenciado com intenso sofrimento pelos indiví-duos e seus familiares (1). Entretanto, mesmo em sofrimento, as famílias têm sido descritas como parte integrante e indispensável na prestação de cuidados emergenciais, pois apoiam a vivência e a adaptação de seus membros à enfermidade aguda e grave (5)(6).…”

Novel Use of Optokinetic Chart Stimulation to Restore Muscle Strength and Function in a Bed Bound Traumatic Brain Injury Patient that was in a Vegetative State of Unconsciousness: A Case Study

“…Most cerebral contusions in severe TBI are associated with high mortalities in elderly patients with TBI [3]. There was no functional progression before commencement of optokinetic chart stimulation.…”

“…Mortality is common among elderly patients post TBI [2]. Even cerebral contusions are associated with high mortalities in elderly patients with TBI [3]. Predictors of outcome after TBI include admission Glasgow Coma Scale (GCS) [4,5], age [6,7], length of stay (LOS) [5,6], midline shift [4]; haematoma size [4], initial functional status [5,6]; and duration of amnesia [5].…”

Acute pain from the perspective of minor trauma patients treated at the emergency unit

“…Trauma, resulting from external causes, has been increasing the morbidity and mortality rate indices in various parts of the world (1)(2) , including in Brazil (3) . The deaths and hospitalizations due to external causes represent, currently, an important problem in public, economic and social health.…”