Citation

Kirkman MA, Jenks T, Bouamra O, Edwards A, Yates D, Wilson M. J. Neurotrauma 2013; 30(16): 1385-1390.

Affiliation

The National Hospital for Neurology and Neurosurgery, Victor Horsley Department of Neurosurgery, London, United Kingdom; matthew.kirkman@gmail.com.

Copyright

(Copyright © 2013, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2013.2881

PMID

23441674

Abstract

Age has been identified as an independent risk factor for poor outcome following head injury in the elderly, and postulated reasons for this include nature, nurture or variations in management. Do elderly head injuries do worse because of a self-fulfilling prophecy of poorer management? The aim of this study was to review the management of patients with cerebral contusions according to age, to identify any trends. We retrospectively reviewed prospectively collected national data on cerebral contusion admissions between 14th March 1988 and 4th May 2012 to UK hospitals held in the Trauma Audit and Research Network (TARN) database. Patients were included in the study if they had: cerebral contusion(s) with an abbreviated injury score (AIS) of three or more; no other head injury with a AIS score of four or more; no injury in any other body region with AIS score of three or more; and known outcome data. In total, 4387 patients met the inclusion criteria. Mortality was found to increase with increasing age (p<0.001). However, time from admission to CT head imaging (p=0.003) and the likelihood of not being transferred to a centre with acute neurosurgical care facilities (p<0.001) increased with increasing age too. Further, there was a significant trend for the most senior grade of doctor to review more younger patients, and for only the most junior grade of doctor to review more older patients (both p<0.001). To conclude, our data suggest differences in management practice may contribute to the observed differences in mortality between younger and older patients suffering brain contusions.

Language: en