Trajectory of disability and quality-of-life in non-geriatric and geriatric survivors after severe traumatic brain injury

Haller, Chiara S.; Delhumeau, Cécile; Pretto, Michael De; Schumacher, Rahel; Pielmaier, Laura; Rebetez, Marie My Lien; Haller, Guy; Walder, Bernhard

doi:10.1080/02699052.2016.1255777

Cited by 36 publications

(29 citation statements)

References 50 publications

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“…While the GOSE is the most widely used measure of global functional outcome following TBI and has been recommended as the standard outcome measure for TBI studies, it has not been validated in the elderly population. One group showed continued improvement in functional outcome in the elderly up to 1-year following severe TBI using the Health Related Quality of Life Measure, an improvement that was not appreciated using the GOSE (23). In addition, the GOSE does not distinguish disability related to neurological impairment from that of systemic injury or illness; one could then postulate that in the setting of increased co-morbidities in the elderly, GOSE scores remain low in the elderly secondary to non-neurological conditions.…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2020

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Introduction: Traumatic brain injury (TBI) is frequently encountered in geriatric patients, but there is a paucity of data describing TBI in the elderly. Here, we show the age of patients with TBI is increasing at our medical center and discuss the relationship between age and injury severity with patient outcomes.Methods: This is a retrospective analysis of 3,179 adult patients with TBI treated at the University of California, Davis Level 1 Trauma Center between 2009 and 2016. Age, Glasgow Coma Scale (GCS), and CT Rotterdam Scores were recorded. Age was analyzed as both a continuous and categorical variable (18-34, 35-50, 51-65, >65 years-old). Extended Glasgow Outcome Scale was obtained at 3 and 6 months and dichotomized into favorable and unfavorable outcomes. Multivariable general linear regression models, chi-square, logistic regression analyses and ANOVA were used for statistical analyses; a p < 0.05 was considered significant.Results: The mean age of patients was 52.2 ± 21.9 years with a male predominance (69%). There was a significant trend (p = 0.002) toward an increase in mean age each year, increasing by 4.4 years (p = 0.008) over the course of the analysis. Older patients had a higher mean GCS compared to younger patients with the same CT Rotterdam Score (p = 0.027), this becoming more pronounced with worse CT Rotterdam Scores. The >65 group had a 4-fold increased risk for unfavorable outcome when compared to the 18-34 group, this effect being most pronounced after mild TBI. Conclusions:The mean age of TBI patients is increasing at our trauma center. The largest disparity in outcomes across age was seen in patients with a mild GCS and low CT Rotterdam Scores, suggesting that these markers of injury severity may underestimate the severity of injury in the elderly population. This information highlights the need for clinical trials and validation of outcome markers in geriatric TBI.

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Section: Discussionmentioning

confidence: 98%

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

et al. 2020

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“…For example, a multi-center, prospective study of older adults with severe TBI found that although these patients experienced significant improvement in physical function over 1 year according to the Health Related Quality of Life Measure, this functional improvement was not detected by the GOSE. 160 Additionally, many in the field rely upon the 1998 GOS and GOSE administration and scoring guide by Wilson and colleagues. 161 Yet, even in this comprehensive guide, scoring of patients with preinjury disability is described as ''problematic.''…”

Section: Outcome Assessmentmentioning

confidence: 99%

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

Gardner

Dams-O’Connor

Morrissey

et al. 2018

Journal of Neurotrauma

307

286

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This review of the literature on traumatic brain injury (TBI) in older adults focuses on incident TBI sustained in older adulthood ("geriatric TBI") rather than on the separate, but related, topic of older adults with a history of earlier-life TBI. We describe the epidemiology of geriatric TBI, the impact of comorbidities and pre-injury function on TBI risk and outcomes, diagnostic testing, management issues, outcomes, and critical directions for future research. The highest incidence of TBI-related emergency department visits, hospitalizations, and deaths occur in older adults. Higher morbidity and mortality rates among older versus younger individuals with TBI may contribute to an assumption of futility about aggressive management of geriatric TBI. However, many older adults with TBI respond well to aggressive management and rehabilitation, suggesting that chronological age and TBI severity alone are inadequate prognostic markers. Yet there are few geriatric-specific TBI guidelines to assist with complex management decisions, and TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include under-representation of older adults in TBI research, lack of systematic measurement of pre-injury health that may be a better predictor of outcome and response to treatment than age and TBI severity alone, and lack of geriatric-specific TBI common data elements (CDEs). This review highlights the urgent need to develop more age-inclusive TBI research protocols, geriatric TBI CDEs, geriatric TBI prognostic models, and evidence-based geriatric TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing geriatric TBI population.

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“…GCS: Glasgow Coma Scale, ED: Emergency Department; HAIS: Head Abbreviated Injury Score; GOSE: Glasgow Outcome Scale extended; SF-12: General assessment instrument of health-related of quality of life. * Reference [30]. …”

Section: Tablementioning

confidence: 99%

Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury

2019

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Traumatic brain injury (TBI) is a major healthcare problem and a major burden to society. The identification of a TBI can be challenging in the prehospital setting, particularly in elderly patients with unobserved falls. Errors in triage on scene cannot be ruled out based on limited clinical diagnostics. Potential new mobile diagnostics may decrease these errors. Prehospital care includes decision-making in clinical pathways, means of transport, and the degree of prehospital treatment. Emergency care at hospital admission includes the definitive diagnosis of TBI with, or without extracranial lesions, and triage to the appropriate receiving structure for definitive care. Early risk factors for an unfavorable outcome includes the severity of TBI, pupil reaction and age. These three variables are core variables, included in most predictive models for TBI, to predict short-term mortality. Additional early risk factors of mortality after severe TBI are hypotension and hypothermia. The extent and duration of these two risk factors may be decreased with optimal prehospital and emergency care. Potential new avenues of treatment are the early use of drugs with the capacity to decrease bleeding, and brain edema after TBI. There are still many uncertainties in prehospital and emergency care for TBI patients related to the complexity of TBI patterns.

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Trajectory of disability and quality-of-life in non-geriatric and geriatric survivors after severe traumatic brain injury

Abstract: Disability decreased and HRQoL improved after TBI between 3-12 months. In geriatric patients this improvement was relevant for HRQoL only.

Cited by 36 publications

References 50 publications

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

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury

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