Traumatic brain injuries in older adults—6 years of data for one UK trauma centre: retrospective analysis of prospectively collected data

Abstract

Objectives Our aim was to determine the incidence of traumatic brain injury (TBI) in older adults and investigate the relationship between injury characteristics and outcomes. Methods Retrospective analysis of prospectively collected data submitted to Trauma Audit and Research Network (TARN) database for a major trauma centre in the West Midlands, UK, from 2008 to 2014. The Mayo Scale was used to categorise TBI. All patients were aged ≥65 years and were admitted with head or brain injuries meeting TARN inclusion criteria: injury resulting in immediate admission to hospital for 3 days, admitted to a high dependency area or death following trauma. We determined age, gender, mechanism of injury, Injury Severity Score, presenting Glasgow Coma Scale (GCS) and Mayo Score, and the association of outcome (Glasgow Outcome Scale (GOS)) with age and clinical presentation.Results 4413 patients were admitted with trauma meeting TARN criteria: 1389 were ≥65 years and 45% (624) had TBI. For patients ≥65 years with TBI, mean age was 79 (range 65-99); 56% were men. Falls accounted for 85% of all TBIs. Most TBIs were moderate/severe (80%) by the Mayo criteria. Of the 279 patients with subdural haematoma, 28% had neurosurgery. Most patients survived TBI (78%); 57% had a good outcome on GOS at discharge (not requiring care package). Mortality was associated with increased age (17% in ages 65-74 years, 19% in 75-84 years, 30% in ≥85 years, p=0.03). Outcome was significantly associated with injury severity ( p=0.0001). Conclusions Patients with TBI represented 45% of all trauma cases meeting TARN inclusion criteria. Falls at home accounted for most TBIs. Most had moderate/ severe TBI, yet over half made a good recovery on GOS. Our data indicate that injury prevention initiatives should focus on home safety. Further research is needed to examine rehabilitation and follow-up after hospital discharge.

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

“…The main cause of trauma in all elderly age groups was fall (Table 1 ), which is in accordance with our earlier findings [ 22 , 28 ] as well as with the results of many other studies [ 8 , 15 , 17 , 19 , 23 , 34 , 36 , 40 ]. Although there was a predominant injury mechanism, there was a notable significant difference between the age groups regarding several other characteristics (Table 1 ).…”

Head injury in the elderly – an overview for the physician

“…Elderly patients suffer high mortality and reduced functional outcome following head injury when compared to younger cohorts; a recent UK cohort study reported 22.9% inpatient mortality, 10.8% long-term moderate disability and 5.3% severe disability requiring permanent help with activities of daily living. 54 Outcomes are considerably worse for severe traumatic brain injury with inpatient mortality as high as 70-80%.…”

Effect of primary decompressive craniectomy on outcomes in severe traumatic brain injury with mass lesions and the independent predictors for operation decision

“…Traumatic brain injury (TBI) presents a great challenge to public health worldwide [1]. In China, TBI is a problem primarily of young and middle aged adults and the proportion of patients with severe TBI is as high as around 20%, leading to huge losses in health and labor capacity [2,3]. Although most small parenchymal lesions do not require surgical evacuation [4], the development of mass effect from larger lesions may result in secondary brain injury, placing the patient at risk of progressive neurological deterioration, refractory intracranial hypertension, herniation, and death [5].…”