Citation

Bobeff EJ, Fortuniak J, Bryszewski B, Wiśniewski K, Bryl M, Kwiecień K, Stawiski K, Jaskólski DJ. World Neurosurg. 2019; ePub(ePub): ePub.

Affiliation

Department of Neurosurgery and Neuro-oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego 22 Street, 90-153 Lodz, Poland. Electronic address: dariusz.jaskolski@umed.lodz.pl.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.wneu.2019.04.060

PMID

30981800

Abstract

Traumatic brain injury (TBI) remains a life-threatening condition characterised by growing incidence worldwide, particularly in aging population, in which the primary goal of treatment appears to be avoidance of chronic institutionalization. To identify independent predictors of 30-day mortality or vegetative state in geriatric population and calculate an intuitive scoring system, we screened 480 patients after TBI treated at single department of neurosurgery in 2-year period. We analysed data of 214 consecutive patients aged ≥65 years: demographics, medical history, cause and time of injury, neurological state, radiological reports and laboratory results. Predictive model was developed using logistic regression modelling with backward stepwise feature selection. Median GCS score on admission was 14 (12-15), whereas 30-day mortality or vegetative state rate amounted to 23.4%. Starting with 20 predefined features, the final prediction model highlighted the importance of GCS motor score (OR 0.17; 95%CI: 0.09-0.32), presence of comorbid cardiac, pulmonary or renal dysfunction or malignancy (OR 2.86; 95%CI: 1.08-7.61), platelets (PLT) ≤100x10⁹cells/L (OR 13.60; 95%CI: 3.33-55.49), and red blood cell distribution width coefficient of variation (RDW-CV) ≥14.5% (OR 2.91; 95%CI: 1.09-7.78). Discovered coefficients were used for nomogram development. It was further simplified to facilitate the clinical use. The proposed scoring system: Elderly Traumatic Brain Injury Score - eTBI Score, yielded similar performance metrics. The eTBI Score is the first scoring system designed specifically for elderly. It could constitute a framework for clinical decision-making and serve as an outcome predictor. Its capability to stratify risk provides reliable criteria for assessing efficacy of TBI management.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

decision making; elderly; prognosis; scoring system; traumatic brain injury