Mortality After Traumatic Brain Injury in Elderly Patients: A New Scoring System

Bobeff, Ernest J.; Fortuniak, Jan; Bryszewski, Bartosz; Wiśniewski, Karol; Bryl, Maciej; Kwiecień, Katarzyna; Stawiski, Konrad; Jaskólski, Dariusz J.

doi:10.1016/j.wneu.2019.04.060

Cited by 17 publications

(13 citation statements)

References 60 publications

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“…However, no significant difference was observed when adjusting the analysis for early admission <24 h after trauma. This finding is similar to other studies [ 10 , 24 ]. A possible explanation for our older group presenting such a high percentage of surgical interventions could be that it reflects the high number of older patients attending the ED with a significant delay and presenting with cSDH as a late complication of head trauma.…”

Section: Discussionsupporting

confidence: 94%

Traumatic brain injury in the elderly after a skiing accident: A retrospective cohort study in a level 1 emergency department in Switzerland

et al. 2022

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Background Skiing is a very popular sport worldwide, with increasing trends over the past decades. This study aimed to evaluate the importance of traumatic brain injury (TBI), especially in the elderly, after a ski accident, and to describe its short-term repercussions. Methodology Patients were analyzed who were admitted to our neurotrauma center from 2012–2018 after a head trauma while skiing. Three different age groups were differentiated and analyzed for the severity of TBI depending on the initial Glasgow Coma Scale as the primary outcome and as secondary outcomes need and type of surgery, Glasgow Outcome Score, preexisting use of anticoagulant or antiplatelet drugs, time to presentation, and pattern of brain injury. TBI severity was adjusted to the time to initial medical consultation. Results No significant difference in TBI severity was found when comparing the middle (>29–54) and older (≥54) age groups to the reference group <30 years (OR:0.45, p = 0.127; OR:0.46, p = 0.17). Acute subdural hemorrhage was present in 21.2% of the ≥55 group and 14.5% of the 30–54 age group, compared to 12.8% of the youngest group (p = <0.001). Overall, 39.4% of the patients in the ≥55 group and 8.1% of the 30–54 age group presented with chronic subdural hemorrhage, whereas none of the youngest patients did (p = <0.001). Conclusion No differences were observed in terms of TBI severity between age groups after acute trauma. Nonetheless, a different pattern of head injury after TBI in older patients was demonstrated. Accordingly, the management differs for these TBIs compared to those of younger patients.

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Section: Discussionsupporting

confidence: 94%

Traumatic brain injury in the elderly after a skiing accident: A retrospective cohort study in a level 1 emergency department in Switzerland

et al. 2022

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“…Our study found that patients with a history of malignancy had lower initial GCS, lower discharge GCS, and longer lengths of stay within the ICU (p < 0.05). This information as markers for severity of injury and outcome seemingly correlates with one of the more recent models in evaluating mortality in patients greater than 65 years old with TBI, which found that factors including history of pulmonary disease, malignancy, renal disease, or cardiac disease were related to increased mortality [ 12 ]. Our cohort, however, was on average younger (average age: 37.56 years) than the previously referenced trial.…”

Section: Discussionmentioning

confidence: 91%

“…In contrast, hypertension is more controversial due to the thought that arterial hypertension may promote the maintenance of cerebral perfusion pressure [ 20 ]. However, recent literature has shown that after TBI, hypertension, especially after the injury, is associated with poorer outcomes [ 12 , 20 ]. This has been theorized to be due to both the maintenance of cerebral perfusion pressure to overcome the increase in intracranial pressure (which is associated with a poorer outcome) as well as from a catecholamine surge [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Medical Comorbidities Associated With Outcomes in Patients With Traumatic Epidural Hematomas

Brazdzionis¹,

Patchana²,

Savla³

et al. 2021

Cureus

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BackgroundTraumatic brain injury (TBI) is a frequently encountered neurosurgical pathology with significant morbidity and mortality. One such subtype is the epidural hematoma. Literature regarding the effects of comorbidities in TBI and epidural hematomas is limited. MethodologyThis was a single-center retrospective review of 50 consecutive patients admitted to a level two trauma center with epidural hematomas. Patients were identified using an internal trauma database. Patients were included if they were 18 years of age with a diagnosed epidural hematoma. Outcome variables of Glasgow coma scale (GCS), length of stay in the intensive care unit (ICU) and hospital, and requirement of a neurosurgical procedure were analyzed. Identification of the presence of diagnosed comorbidities was performed including common comorbidities such as obesity, diabetes, hypertension, hyperlipidemia, drug use, tobacco use, cancer, psychiatric disease, and renal disease. Correlations were evaluated using two-sided bivariate analysis (p < 0.05). ResultsA total of 50 patients were included for analysis. Significant correlations with a p-value less of than 0.05 were noted in initial GCS and cancer (r = -0.357, p = 0.011), requirements of an intracranial procedure with a history of gastrointestinal disease (r = 0.377, p = 0.007), and younger age (r = -0.306, p = 0.031). Increased ICU length of stay was related to a history of cancer (r = 0.494, p < 0.001), a history of respiratory disease (r = 0.427, p = 0.002), and a history of psychiatric disease (r = 0.297, p = 0.036). Increased hospital length of stay was related to psychiatric disorders (r = 0.285, p = 0.045). Discharge GCS was negatively associated with a history of hypertension (r = -0.374, p = 0.008), tobacco use (r = -0.417, p = 0.003), drug use (r = -0.294, p = 0.037), and history of cancer (r = -0.303, p = 0.032). Discussion and ConclusionsIn our 50 consecutive patient subset, selected comorbidities demonstrated significant relationships with outcome measures of GCS, need for a procedure, and lengths of stay in the hospital and ICU. Obtaining comorbidity information when available from families can better allow the clinician to optimize treatment and educate loved ones about the potential effects of these comorbidities on the overall health of the patient. Understanding these correlations may allow for a better understanding of the systemic effects of the pathophysiology of injury in epidural hematomas.

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“…67 Moreover, GCS variation from baseline can be uncertain and slow, and even determining the baseline condition can be difficult in patients with dementia. Recently, new scores for the evaluation of older adults after head trauma such as eTBI 68 have been proposed.…”

Section: Discussionmentioning

confidence: 99%

The state of the art of the management of anticoagulated patients with mild traumatic brain injury in the Emergency Department

et al. 2022

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The effects of Oral Anticoagulation Therapy (OAT) in older patients who suffered a mild Traumatic Brain Injury (mTBI) are widely debated but still strong guidelines are lacking and clinical approaches and management are sometimes heterogeneous. Different predictors of adverse outcomes were identified in the literature but their use in the decision-making process is unclear. Moreover, there is no consensus on the appropriate length of stay in the Observation Unit nor on the continuation of OAT, even if the diagnosis of life-threatening delayed post-traumatic Intracranial Hemorrhage is rare. The recurrence of a control CT scan is often needless. This review aims to summarize recent scientific literature focusing on patients with mTBI taking OAT and to identify crucial questions on the topic to suggest a best clinical practice.

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Mortality After Traumatic Brain Injury in Elderly Patients: A New Scoring System

Cited by 17 publications

References 60 publications

Traumatic brain injury in the elderly after a skiing accident: A retrospective cohort study in a level 1 emergency department in Switzerland

Traumatic brain injury in the elderly after a skiing accident: A retrospective cohort study in a level 1 emergency department in Switzerland

Medical Comorbidities Associated With Outcomes in Patients With Traumatic Epidural Hematomas

The state of the art of the management of anticoagulated patients with mild traumatic brain injury in the Emergency Department

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