What are the demographic and clinical differences between those older adults with traumatic brain injury who receive a neurosurgical intervention to those that do not? A systematic literature review with narrative synthesis

Barrett, Jack W; Williams, Julia; Griggs, Joanna; Skene, Simon; Lyon, Richard L

doi:10.1080/02699052.2022.2093398

Cited by 3 publications

(2 citation statements)

References 52 publications

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“…There are no guidelines for the treatment of severe TBI and DC in older adults. The decision to treat aggressively or conservatively or to withhold treatment in older adults is a difficult balance between medical knowledge, experience and assessment of the physicians on the ( 108 ) one hand and the (presumed) will of the patient on the other ( 109 ). Nevertheless, Skaansar et al showed that the intensity of treatment in patients with TBI decreases with increasing age, and that low intensity of management is associated with an increased risk of 30-day mortality ( 110 ).…”

Section: Discussionmentioning

confidence: 99%

Outcome after decompressive craniectomy in older adults after traumatic brain injury

Kapapa,

Jesuthasan,

Schiller

et al. 2024

Front. Med.

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ObjectiveGlobally, many societies are experiencing an increase in the number of older adults (>65 years). However, there has been a widening gap between the chronological and biological age of older adults which trend to a more active and social participating part of the society. Concurrently, the incidence of traumatic brain injury (TBI) is increasing globally. The aim of this study was to investigate the outcome after TBI and decompressive craniectomy (DC) in older adults compared with younger patients.MethodsA retrospective, multi-centre, descriptive, observational study was conducted, including severe TBI patients who were treated with DC between 2005 and 2022. Outcome after discharge and 12 months was evaluated according to the Glasgow Outcome Scale (Sliding dichotomy based on three prognostic bands). Significance was established as p ≤ 0.05.ResultsA total of 223 patients were included. The majority (N = 158, 70.9%) survived TBI and DC at discharge. However, unfavourable outcome was predominant at discharge (88%) and after 12 months (67%). There was a difference in favour of younger patients (≤65 years) between the age groups at discharge (p = 0.006) and at 12 months (p < 0.001). A subgroup analysis of the older patients (66 to ≤74 vs. ≥75 years) did not reveal any significant differences. After 12 months, 64% of the older patients had a fatal outcome. Only 10% of those >65 years old had a good or very good outcome. 25% were depending on support in everyday activities. After 12 months, the age (OR 0.937, p = 0.007, CI 95%: 0.894–0.981; univariate) and performed cranioplasty (univariate and multivariate results) were influential factors for the dichotomized GOS. For unfavourable outcome after 12 months, the thresholds were calculated for age = 55.5 years (p < 0.001), time between trauma and surgery = 8.25 h (p = 0.671) and Glasgow Coma Scale (GCS) = 4 (p = 0.429).ConclusionEven under the current modern conditions of neuro-critical care, with significant advances in intensive care and rehabilitation medicine, the majority of patients >65 years of age following severe TBI and DC died or were dependent and usually required extensive support. This aspect should also be taken into account during decision making and counselling (inter-, intradisciplinary or with relatives) for a very mobile and active older section of society, together with the patient’s will.

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Section: Discussionmentioning

confidence: 99%

Outcome after decompressive craniectomy in older adults after traumatic brain injury

Kapapa,

Jesuthasan,

Schiller

et al. 2024

Front. Med.

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“…In addition, a high recurrence of SDH is an important factor against the long-term outcome of surgery for these patients. SDH is the most frequent brain injury after TBI [6]. Some researchers theorized that an acute SDH after minor head trauma, especially in elderly patients, could be related to the antithrombotic drugs [7,8].…”

Section: Background and Aimsmentioning

confidence: 99%

The impact of oral anticoagulants on the characteristics of subdural hematomas and other brain lesions in patients with traumatic brain injury

Pastor

Para

Vesa

et al. 2023

Medicine and Pharmacy Reports

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Background and aim. The aim of the study was to determine the impact of prior anticoagulant treatment on the characteristics of intracranial hematomas. Methods. We included in this retrospective study 135 patients who were diagnosed with subdural hematoma in the context of traumatic brain injury. We recorded the demographic and clinical data, the paraclinical examinations and the characteristics of subdural hematoma evidenced by preoperative computed tomography (CT). We also reported the other brain injuries, entailed by primary and secondary lesions, as described by CT. Results. The anticoagulation therapy was recorded in 35 patients, at the moment of diagnosis. Acute subdural hematoma was recorded in 89 (65.9%) patients, 21 (60%) of these had anticoagulation therapy on admission. There were 46 (34.1%) patients with chronic subdural hematoma, 14 (40%) of these were on anticoagulant therapy. The midline shift was significantly moved in patients with anticoagulation therapy. The thickness of the subdural hematoma was significantly higher in patients with anticoagulation. We did not find any significant association of the other brain lesions (cranial fracture, extradural hematoma, intraparenchymal hematoma, nor intracranial hypertension, brain herniation, brain swelling), and the presence of anticoagulation therapy. Conclusion. The study showed that anticoagulants significantly influence some neuroimaging aspects of the SDH in head trauma.

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Characterizing Interhospital Variability in Neurosurgical Interventions for Patients with Mild Traumatic Brain Injury and Intracranial Hemorrhage

Orlando

Coresh

Carrick

et al. 2023

Neurotrauma Reports

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What are the demographic and clinical differences between those older adults with traumatic brain injury who receive a neurosurgical intervention to those that do not? A systematic literature review with narrative synthesis

Cited by 3 publications

References 52 publications

Outcome after decompressive craniectomy in older adults after traumatic brain injury

Outcome after decompressive craniectomy in older adults after traumatic brain injury

The impact of oral anticoagulants on the characteristics of subdural hematomas and other brain lesions in patients with traumatic brain injury

Characterizing Interhospital Variability in Neurosurgical Interventions for Patients with Mild Traumatic Brain Injury and Intracranial Hemorrhage

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