Rolf Erlebach1, Alberto Pagnamenta2, Stephanie Klinzing1, Federica Stretti1,3, Silvia Cottini1, Reto Schüpbach1, Peter Steiger1, Giovanna Brandi4. 1. Unit of Surgical Intensive Care, University Hospital of Zurich, Zurich, Switzerland. 2. Unit of Clinical Epidemiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland. 3. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. 4. Unit of Surgical Intensive Care, University Hospital of Zurich, Zurich, Switzerland - giovanna.brandi@usz.ch.
Abstract
BACKGROUND: The purpose of the present study was to analyze clinical features of patients with traumatic brain injury (TBI), their age-related outcomes and determinants of long-term outcome. METHODS: This retrospective cohort study was conducted in a level I University Swiss trauma center. Consecutive patients with moderate to severe TBI admitted for more than 48 hours to the Intensive Care Unit (ICU) were included. Patients' and trauma characteristics, management during ICU stay, prognostic scores and long-term outcomes were analyzed. RESULTS: Hundred-seventy-four patients (72% males, mean age 49 years) were divided in three age groups: young (≤39 years, N.=69, 39.7%), middle aged (40-64 years, N.=55, 31.6%), and elderly (≥65 years, N.=50, 28.7%). In elderly patients, falls (62%) were the most common cause of TBI. Overall ICU mortality was 15% with no difference among age groups. Within six-months after TBI, 80% of elderly patients presented unfavorable outcomes. Age, pre-existing cardiovascular disease, use of anticoagulants and/or antiplatelet agents, abnormal pupillary reactivity, a high score in Marshall CT classification, and a higher glucose level were associated with unfavorable outcomes in a univariable logistic regression. In a multivariable logistic regression, age and abnormal pupillary reactivity were identified as independent risk factors for unfavorable outcomes, while presence of epidural hematoma and higher hemoglobin levels were predictors for favorable outcomes. CONCLUSIONS: Older patients are at higher risk for long-term unfavorable outcomes than younger patients. Use of anticoagulants and/or antiplatelet agents and lower hemoglobin levels during rescue phase are associated with unfavorable long-term outcomes. Fall prevention in the elderly should be a key target of intervention programs.
BACKGROUND: The purpose of the present study was to analyze clinical features of patients with traumatic brain injury (TBI), their age-related outcomes and determinants of long-term outcome. METHODS: This retrospective cohort study was conducted in a level I University Swiss trauma center. Consecutive patients with moderate to severe TBI admitted for more than 48 hours to the Intensive Care Unit (ICU) were included. Patients' and trauma characteristics, management during ICU stay, prognostic scores and long-term outcomes were analyzed. RESULTS: Hundred-seventy-four patients (72% males, mean age 49 years) were divided in three age groups: young (≤39 years, N.=69, 39.7%), middle aged (40-64 years, N.=55, 31.6%), and elderly (≥65 years, N.=50, 28.7%). In elderly patients, falls (62%) were the most common cause of TBI. Overall ICU mortality was 15% with no difference among age groups. Within six-months after TBI, 80% of elderly patients presented unfavorable outcomes. Age, pre-existing cardiovascular disease, use of anticoagulants and/or antiplatelet agents, abnormal pupillary reactivity, a high score in Marshall CT classification, and a higher glucose level were associated with unfavorable outcomes in a univariable logistic regression. In a multivariable logistic regression, age and abnormal pupillary reactivity were identified as independent risk factors for unfavorable outcomes, while presence of epidural hematoma and higher hemoglobin levels were predictors for favorable outcomes. CONCLUSIONS: Older patients are at higher risk for long-term unfavorable outcomes than younger patients. Use of anticoagulants and/or antiplatelet agents and lower hemoglobin levels during rescue phase are associated with unfavorable long-term outcomes. Fall prevention in the elderly should be a key target of intervention programs.