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Affiliation
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Lund University Hospital, Dept of Neurosurgery, Getingevägen 4, 221 85 Lund, Sweden. Electronic address: Gregor.Tomasevic@med.lu.se. |
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Abstract
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OBJECTIVE: Despite recent progress, prognosis for the elderly (defined as aged 70 or more) afflicted by Traumatic Brain Injury (TBI) is unfavorable and surgical intervention remains controversial. Research during the last decade on the mortality rates or prognostic factors for survival in the elderly is limited.
METHODS: We analyzed 97 patients aged 70 or more who were treated surgically for closed TBI at our neurosurgical unit between Jan 1, 2003 and Dec 31, 2012. In addition, we analyzed 22 patients aged 70 or more who had sustained a closed TBI and on whom no neurosurgical intervention was performed. Outcome in both groups was measured as 30-, 90- and 180-day mortality.
RESULTS: Surgically treated patients: median age was 76 years. 30-day overall mortality rate was 36%. Higher mortality was seen with lower level of consciousness (LOC), high energy trauma, one pupil fixed and dilated, and more extensive intracranial pathology. Presence of warfarin, higher age or degree of midline shift were not associated with worsened outcome. Patients not treated neurosurgically: median age was 81.5 years. 30-day overall mortality was 23%. Mortality for patients in GCS 10-15 was 6%, GCS 6-9 67% and GCS 3-5 100% CONCLUSION: Selected patients aged 70 or more can benefit from surgical intervention for closed TBI. LOC, radiological type of injury, mechanism of injury and pupil abnormalities should be carefully evaluated. There also seems to exist a group of patients in whom surgical intervention offers little benefit, as mortality rate is low without surgical intervention.
Language: en |