Citation

Wan X, Liu S, Wang S, Zhang S, Yang H, Ou Y, Zhao M, James L, Shu K, Chen J, Lei T. World Neurosurg. 2016; 89: 147-152.

Affiliation

Department of Neurosurgery, Tongji hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.wneu.2016.01.084

PMID

26855305

Abstract

BACKGROUND: Whether aggressive or conservative managements should be used for the elderly patients with severe traumatic brain injury (TBI) remains controversial. This study aimed to assess the outcome of surgical alternatives for treatment of the severe traumatic intracranial hematoma (TIH) in patients aged 65 years or older and identify the factors that may contribute to the outcome.

METHODS: This retrospective study included a cohort of 112 TIH patients. The logistic regression analysis was used to identify independent predictors of unfavorable outcome. The Glasgow Outcome Scale (GOS) was applied to evaluate the outcome.

RESULTS: Of all the patients aged 65 years or older, 70 (62.5%) were operated. Favorable outcome and mortality of patients receiving operation occurred in 33 (47.1%) patients and 23 (32.9%) patients respectively. Patients with operation were less likely to have unfavorable outcome (52.9% vs.95.2%) and to die (32.9% vs. 88.1%) at 6 months post-injury compared with those treated conservatively. Multivariate logistic regression analysis revealed that lower Glasgow coma scale score (GCS≤5) (P<0.001) was a significant factor associated with unfavorable outcome (odds ratio(OR), 18.7; 95% confidence interval(CI) 5.2-95.5, P<0.001) and mortality (OR, 10.7; 95% CI 4.4-28.5, P<0.001); However, neurosurgical intervention (P<0.001) was a significant factor to negatively predict the unfavorable outcome(OR, 0.03; 95% CI 0.01-0.1, P<0.001) and mortality(OR, 0.04; 95% CI 0.01-0.1, P<0.001).

CONCLUSIONS: This study showed that GCS score (GCS≤5) was a major determinant of outcome in the geriatric severe TBI patients. However, the surgical treatment could reduce the mortality and improve the outcome in the elderly patients.

Language: en