Traumatic Brain Injury in the Elderly: Clinical Features, Prognostic Factors, and Outcomes of 133 Consecutive Surgical Patients

Abstract

Objective With the aging of the global population, an increase in the proportion of elderly patients presenting with traumatic brain injury (TBI) is expected. This population presents several distinctive characteristics that impact management and outcome of TBI, such as comorbidities, frailty, and preinjury use of medications - specially antiplatelets and anticoagulants. The purpose of this study was to assess the general characteristics and prognostic factors of elderly patients with TBI that were surgically managed at a single institution. Methods The authors performed a retrospective review of all elderly patients (age ≥ 65 years) with a history of TBI that underwent cranial neurosurgical procedures at their institution, between 2015 and 2019. Clinical characteristics, laboratory tests, and radiological scans, as well as surgeries, performed, outcome, and prognostic factors were analyzed, comprising 133 consecutive cases overall. Results The mean age of patients was 76.6 ± 7.3 years, ranging from 65 years to 97 years. There was a predominance of males (71.4%) and the most frequent mechanism of injury was fall (80.4%). Mild TBI comprised 57.1% of the cases, followed by severe TBI in 25.6%. Frequent signs and symptoms were impaired consciousness (69.9%), focal motor deficits (32.3%), and gait disturbances (12.8%). The majority had reported comorbidities upon admission (79.7%), with cardiac disease (79.2%) and diabetes (24.5%) as the most frequent. Preinjury anticoagulation was reported in 18.8% and use of antiplatelet drugs in 17.3%. The most common finding in the head CT was chronic subdural hematoma (48.1%), followed by acute subdural hematoma (37.6%). Coagulation was found to be altered in 12.8% of the patients. The most common neurosurgical procedure performed was trephination for hematoma evacuation (56.3%), followed by craniotomy (21.2%). Blood product transfusion was needed in 61.7% of the patients. Overall mortality was 42.1%, with the majority in the first month after admission (83.9%). Unfavorable outcome (Glasgow Outcome Scale <5) at discharge was identified in 73% of the patients. Identified prognostic factors were TBI severity, absent pupillary reactivity, acute intracranial bleeding on head CT, basal cisterns obliteration, altered coagulation status, and need for blood transfusion. Conclusions TBI severity, pupillary reactivity, coagulation status, need for blood products transfusion and acute bleeding, as well as basal cisterns obliteration found in head CT, are factors that influenced the outcome in this series of elderly patients with TBI that need surgical management. It is paramount to observe the particularities of this population in this context, to optimize outcomes, avoid complications and ultimately generate awareness focused on prevention.

Đặc Điểm Lâm Sàng Và Kết Quả Điều Trị Chấn Thương Sọ Não Ở Người Cao Tuổi Tại Bệnh Viện Đa Khoa Tỉnh Thái Bình

“…Tỉ lệ chấn thương sọ não gặp ở nam giới là chủ yếu chiếm 65%, nữ giới chiếm 35%, tỉ lệ nam/nữ là 1,86. Các nghiên cứu của Podolsky-Gondim, Hawley cũng chỉ ra rằng tỉ lệ nam giới gặp nhiều hơn nữ giới [3,4]. Té ngã là nguyên nhân chủ yếu gặp ở người cao tuổi trong nghiên cứu này, nguyên nhân do té ngã chiếm 47,9%, sau đó là nguyên nhân do tai nạn giao thông chiếm 43,8%, Khi độ tuổi càng tăng, tỉ lệ chấn thương sọ não do té ngã tăng từ 70% lên 88% trong khi tỉ lệ chấn thương sọ não do tai nạn giao thông giảm từ 11% xuống 4% [5].…”

“…Điểm tri giác theo thang điểm GCS của bệnh nhân lúc nhập viện chủ yếu là tình trạng chấn thương sọ não nhẹ (GCS 13-15 điểm) chiếm 91,5%, chấn thương sọ não mức độ trung bình chiếm 6,7%, chỉ có 1,7% là chấn thương sọ não mức độ nặng. Các nghiên cứu của Prasad và Podolsky-Gondim bệnh nhân khi nhập viện chủ yếu thuộc nhóm chấn thương sọ não nhẹ [2,3]. Do đa số bệnh nhân nhập viện có điểm GCS từ 13 -15 điểm nên ý thức còn tốt, các chấn thương va đập vùng đầu (vết thương, sưng nề, tụ máu dưới da) và các tổn thương nội sọ bên trong gây ra các triệu chứng khó chịu cho bệnh nhân, trong đó đau đầu là chủ yếu chiếm 94,4%, buồn nôn, nôn chiếm 11,1%, các dấu hiệu của vỡ nền sọ trước, nền sọ giữa (chảy máu mũi, chảy máu tai) chiếm lần lượt 2,8% và 5,4%.…”

Severe bleeding in the ICU

“…It is the subject of ongoing research if the elucidated strict transfusion strategies are transferable to patients treated for traumatic brain injury [28 ▪ ,29 ▪ ,30].…”

Comparative Analysis of Antithrombotic Therapy Outcomes in Mild Traumatic Brain-Injury Patients: A Focus on Bleeding Risk and Hospital-Stay Duration

“…With the aging of the global population, an increase in the proportion of elderly patients presenting with traumatic brain injury (TBI), defined as a disturbance in the functioning of the brain or evidence of brain pathology that results from an external physical force, is expected [ 1 , 2 , 3 ]. Indeed, in recent years, instances of neurotrauma in the elderly have been increasing [ 4 , 5 ].…”