Predictors of in-hospital mortality and 6-month functional outcomes in older adults after moderate to severe traumatic brain injury

Utomo, Wesley K.; Gabbe, Belinda; Simpson, Pamela; Cameron, Peter

doi:10.1016/j.injury.2009.05.034

Cited by 144 publications

(91 citation statements)

References 22 publications

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“…In this study, it was found that the characteristics of the victims are related to the mechanisms of trauma, in which young adults engage more frequently in high-speed motor vehicle accidents, while the elderly, in falls, which corroborates the literature 14,15 . Also, the physiological condition on RTS was similar to data from another study that found a score greater than six 16 .…”

Section: Discussionsupporting

confidence: 87%

Predictors of quality of life after moderate to severe traumatic brain injury

Weber

Guimarães

Pontes-Neto

et al. 2016

Arq. Neuro-Psiquiatr.

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Objective To verify correlations between age, injury severity, length of stay (LOS), cognition, functional capacity and quality of life (QOL) six months after hospital discharge (HD) of victims of traumatic brain injury (TBI). Method 50 patients consecutively treated in a Brazilian emergency hospital were assessed at admission, HD and six months after HD. The assessment protocol consisted in Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Mini Mental Test, Barthel Index and World Health Organization QOL - Brief. Results Strong negative correlation was observed between LOS and GCS and LOS and RTS. An almost maximal correlation was found between RTS and GCS and functional capacity and GCS at HD. Age and LOS were considered independent predictors of QOL. Conclusion Age and LOS are independent predictors of QOL after moderate to severe TBI.

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Section: Discussionsupporting

confidence: 87%

Predictors of quality of life after moderate to severe traumatic brain injury

Weber

Guimarães

Pontes-Neto

et al. 2016

Arq. Neuro-Psiquiatr.

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“…Previous studies of TBI in patients over 65 years of age have shown that age and GCS score are independent predictors of an unfavorable outcome. 24,27 Indeed, all patients with severe TBI were dependent in daily living activities 6 months after injury, and the mortality rate was 24 times higher than that in patients with a good GCS score. 27 Similarly, the severity of aSDH, as part of TBI, has been reported to be an independent predictor of poor prognosis in several studies observing a younger cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

“…24,27 Indeed, all patients with severe TBI were dependent in daily living activities 6 months after injury, and the mortality rate was 24 times higher than that in patients with a good GCS score. 27 Similarly, the severity of aSDH, as part of TBI, has been reported to be an independent predictor of poor prognosis in several studies observing a younger cohort of patients. 2,3,21,28 Our analysis of elderly patients over 80 years of age showed the same results, suggesting that for either young or old patients, the severity of aSDH is the Mean values are expressed with standard deviations.…”

Section: Discussionmentioning

confidence: 99%

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Won¹,

Dubinski²,

Brawanski³

et al. 2017

Neurosurgical Focus

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OBJECTIVEAcute subdural hematoma (aSDH) is a common disease increasing in prevalence given the demographic growth of the aging population. Yet, the benefit of surgical treatment for aSDH and the subsequent functional outcome in elderly patients (age ≥ 80 years) remain unclear. Therefore, the aims of this study were to evaluate the incidence of aSDH in patients 80 years or older, determine overall functional outcome, identify predictors of an unfavorable or favorable outcome, and establish specific risk factors for seizures.METHODSThe authors retrospectively analyzed patients 80 years and older who presented with isolated aSDH in the past 10 years at their institution. The following parameters were assessed: baseline characteristics, clinical status on admission and 24 hours after surgery, and clinical course. Functional outcome was assessed at discharge and the 3-month follow-up (FU).RESULTSIn the period from January 2007 to December 2016, 165 patients with aSDH were admitted to the authors’ institution. Sixty-eight patients (41.2%) were 80 years old or older, and the mean age overall was 85 years (range 80–96 years). The incidence of aSDH in the elderly had significantly increased over past decade, with more than 50% of patients admitted to our institution for aSDH now being 80 years or older. The overall mortality rate was 28% at discharge and 48% at the FU. Independent predictors of an unfavorable outcome at discharge were a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and pneumonia (p < 0.02). At the FU, a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and cumulative comorbidities (≥ 5; p < 0.05) were significant independent predictors. All patients with more than 6 comorbidities had died by the FU. Surgical treatment in comatose compared to noncomatose patients had statistically significant, higher mortality rates at discharge and the FU. Still, 23% of the comatose patients and more than 50% of the noncomatose patients had a favorable outcome at the FU (p = 0.06).CONCLUSIONSThe number of octo- and nonagenarians with aSDH significantly increased over the last decade. These patients can achieve a favorable outcome, especially those with a noncomatose status and fewer than 5 comorbidities. Surgical and nonsurgical treatment of octo- and nonagenarians during and after discharge should be optimized to increase clinical improvement.

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“…Extrasynaptic mitochondria do not display elevated levels of oxidative stress with age (Gilmer et al, 2010), supporting previous findings indicating that this fraction may be better equipped to compensate for oxidative damage. Clinical data strongly suggest that an individual's age at the time of injury negatively correlates with positive outcome, but positively correlates with increased mortality (Utomo et al, 2009). However, there is considerable disagreement as to the critical age at which these changes begin to have a significant influence (Chesnut et al, 2000;Coronado et al, 2005;Flaada et al, 2007;Hukkelhoven et al, 2003;Jacoby et al, 2006;Mosenthal et al, 2002Mosenthal et al, , 2004Richmond et al, 2002;Rothweiler et al, 1998;Vollmer et al, 1991).…”

Section: Discussionmentioning

confidence: 99%

Age-Related Mitochondrial Changes after Traumatic Brain Injury

Gilmer

Ansari

Roberts

et al. 2010

Journal of Neurotrauma

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Mitochondrial dysfunction is known to occur following traumatic brain injury (TBI) and has been well characterized. This study assessed possible age-related changes in the cortical mitochondrial bioenergetics following TBI. Three hours following a moderate TBI, tissue from the ipsilateral hemisphere (site of impact and penumbra) and the corresponding contralateral region were harvested from young (3-to 5-month-old) and aged (22-to 24-month-old) Fischer 344 rats. Synaptic and extrasynaptic mitochondria were isolated using a Ficoll gradient, and several bioenergetic parameters were examined using a Clark-type electrode. Injury-related respiration deficits were observed in both young and aged rats. Synaptic mitochondria showed an age-related decline in the rate of ATP production, and a decline in respiratory control ratios (RCR), which were not apparent in the extrasynaptic fraction. Following respiration analysis, mitochondrial samples were probed for oxidative damage (3-nitrotyrosine [3-NT], 4-hydroxynonenal [4-HNE], and protein carbonyls [PC]). All markers of oxidative damage were elevated with injury and age in the synaptic fraction, but only with injury in the extrasynaptic fraction. Synaptic mitochondria displayed the highest levels of oxidative damage and may contribute to the synaptic bioenergetic deficits seen following injury. Data indicate that cortical synaptic mitochondria appear to have an increased susceptibility to perturbation with age, suggesting that the increased mitochondrial dysfunction observed following injury may impede recovery in aged animals.

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Predictors of in-hospital mortality and 6-month functional outcomes in older adults after moderate to severe traumatic brain injury

Cited by 144 publications

References 22 publications

Predictors of quality of life after moderate to severe traumatic brain injury

Predictors of quality of life after moderate to severe traumatic brain injury

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Age-Related Mitochondrial Changes after Traumatic Brain Injury

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