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Affiliation
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Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, INDIA. |
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Abstract
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BACKGROUND: The increasing ratio of elderly population has contributed to increased incidence of TBI in this cohort. Authors put forward their institutional experience in the management of elderly TBI.
MATERIALS AND METHODS: A 3-year retrospective analysis of 73 consecutive patients aged ≥ 65 years admitted with TBI at our university hospital was performed. The following were excluded-concussion injuries, chronic subdural hematomas (SDH), patients discharged against medical advice (DAMA) and declared dead soon after arrival (within 6 hours). Mode of injury, clinico-radiological features, management and outcomes were analysed. Glasgow outcome scale (GOS) was used to assess outcome.
RESULTS: Males predominated (82%). Mean age was 72.1 years (range 65-97 years) and 20 were aged≥75 years. There were 37 mild, 18 moderate and 18 severe head injuries (HI). Contusions constituted the majority. Fifty-five(75%) cases were managed conservatively while 18(25%) underwent surgery. There were 7 deaths(9.5%). Overall, poor outcome was 26%, while being 45% in patients aged ≥75years. Poor outcome in severe HI for the entire cohort was 83% (15/18) but was 100% (7/7) for the very elderly patients. On univariate analysis, age≥75 years, severe HI, acute SDH and surgical management were significantly associated with poor outcome while acute SDH and surgical management were significant on multilogistic regression analysis.
CONCLUSIONS: Age ≥75 years, severe HI and acute SDH are poor prognostic factors. Benefit of surgery in such conditions is unlikely and surgery needs to be judiciously considered keeping in mind the economics involved and fate of caregivers, especially in developing countries.
Copyright © 2017 Elsevier Inc. All rights reserved.
Language: en |