Citation

Lenell S, Nyholm L, Lewén A, Enblad P. Acta Neurochir. (Wien) 2019; 161(6): 1243-1254.

Affiliation

Department of Neuroscience/Neurosurgery, Section of Neurosurgery, Uppsala University Hospital, Uppsala University, SE-751 85, Uppsala, Sweden.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00701-019-03893-6

PMID

30980243

Abstract

BACKGROUND: The probability of favorable outcome after traumatic brain injury (TBI) decreases with age. Elderly, ≥ 60 years, are an increasing part of our population. Recent studies have shown an increase of favorable outcome in elderly over time. However, the optimal patient selection and neurointensive care (NIC) treatments may differ in the elderly and the young. The aims of this study were to examine outcome in a larger group of elderly TBI patients receiving NIC and to identify demographic and treatment related prognostic factors.

METHODS: Patients with TBI ≥ 60 years receiving NIC at our department between 2008 and 2014 were included. Demographics, co-morbidity, admission characteristics, and type of treatments were collected. Clinical outcome at around 6 months was assessed. Potential prognostic factors were included in univariate and multivariate regression analysis with favorable outcome as dependent variable.

RESULTS: Two hundred twenty patients with mean age 70 years (median 69; range 60-87) were studied. Overall, favorable outcome was 46% (Extended Glasgow Outcome Scale (GOSE) 5-8), unfavorable outcome 27% (GOSE 2-4), and mortality 27% (GOSE 1). Significant independent negative prognostic variables were high age (p < 0.05), multiple injuries (p < 0.05), GCS M ≤ 3 on admission (p < 0.05), and mechanical ventilation (p < 0.001).

CONCLUSIONS: Overall, the elderly TBI patients > 60 years receiving modern NIC in this study had a fair chance of favorable outcome without large risks for severe deficits and vegetative state, also in patients over 75 years of age. High age, multiple injuries, GCS M ≤ 3 on admission, and mechanical ventilation proved to be independent negative prognostic factors. The results underline that a selected group of elderly with TBI should have access to NIC.

Language: en

Keywords

Elderly; Neurointensive care; Outcome; Prognostic factors; Quality register; Traumatic brain injury