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Citation
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Yokobori S, Saito K, Sasaki K, Kanaya T, Fujiki Y, Yamaguchi M, Satoh S, Watanabe A, Igarashi Y, Suzuki G, Kaneko J, Nakae R, Onda H, Ishinokami S, Takayama Y, Noae Y, Sato H, Unemoto K, Fuse A, Yokota H. J. Nippon Med. Sch. 2020; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Due to aging of the Japanese population, traumatic brain injuries (TBI) in elderly individuals have increased. However, the effectiveness and prognosis of intensive treatment in geriatric TBI have not yet been determined. Thus, we analyzed the prognostic factors of intensive and aggressive treatments using nationwide data from Japan Neurotrauma Data Bank (JNTDB) projects.
METHODS: We analyzed 1,879 geriatric TBI cases (≥65 years old) registered in four JNTDB projects, Project 1998 (P1998) to Project 2015 (P2015). Clinical features, aggressive treatment usage, and 6-month outcomes on the Glasgow Outcome Scale (GOS) were compared among study projects. Logistic regression was performed to clarify prognostic factors in aggressively-treated patients.
RESULTS: The percentage of geriatric TBI cases significantly increased across time (P1998: 30.1%, Project 2004 (P2004) : 34.6%, Project 2009 (P2009) : 43.9%, P2015: 53.6%, p<0.0001). Aggressive treatment usage also significantly increased, from 67.0% in P1998 to 69.3% in P2015 (p<0.0001). Less invasive methods, such as trepanation and normothermic targeted temperature management, were more often chosen for geriatric patients. These efforts resulted in a significant decrease in the 6-month mortality rate, from 76.2% in P1998 to 63.1% in P2015 (p=0.0003), although the percentage of severely disabled patients increased, from 8.9% in P1998 to 11.1% in P2015 (p = 0.0003). Intraventricular hemorrhage was the most unfavorable prognostic factor for the 6-month outcome (OR 3.79, 95% CI 1.78-8.06, p<0.0001).
CONCLUSIONS: Less invasive treatments reduce mortality in geriatric TBI but do not improve functional outcomes. The patients' age does not seem to be the strongest prognostic factor; thus, physicians should not adhere to only age.
Language: en |