G Lakshmi Prasad1, N Anmol2, Girish R Menon2. 1. Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, India. Electronic address: lakshmi.prasad@manipal.edu. 2. Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, India.
Abstract
BACKGROUND: The growing elderly population has contributed to an increasing incidence of traumatic brain injury (TBI) in this cohort worldwide. Here we describe our institutional experience in the management of TBI in elderly Indian patients. METHODS: This was a 3-year retrospective analysis of 73 consecutive patients age ≥65 years admitted to our university hospital with TBI. Exclusion criteria included a history of concussion injury, chronic subdural hematoma (SDH), discharge against medical advice, and declared dead within 6 hours after arrival. Mode of injury, clinicoradiologic features, management, and outcomes were analyzed. The Glasgow Outcome Scale (GOS) was used to assess outcome. RESULTS: Our cohort was predominately male (82%). The mean patient age was 72.1 years (range, 65-97 years), and 20 were age ≥75 years. Head injuries (HIs) were mild in 37 patients, moderate in 18, and severe in 18. The majority of injuries were contusions. Fifty-five patients (75%) were managed conservatively, and 18 (25%) underwent surgery. There were 7 deaths (9.5%). The rate of poor outcome was 26% overall, and 45% in patients age ≥75 years. Poor outcome in severe HI was seen in 83% (15 of 18) of the entire cohort but in 100% (7 of 7) of 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 in patients with TBI. The benefit of surgery in these patients is unlikely, and surgery needs to weighed judiciously, keeping in mind the economics involved and the fate of caregivers, especially in developing countries.
BACKGROUND: The growing elderly population has contributed to an increasing incidence of traumatic brain injury (TBI) in this cohort worldwide. Here we describe our institutional experience in the management of TBI in elderly Indian patients. METHODS: This was a 3-year retrospective analysis of 73 consecutive patients age ≥65 years admitted to our university hospital with TBI. Exclusion criteria included a history of concussion injury, chronic subdural hematoma (SDH), discharge against medical advice, and declared dead within 6 hours after arrival. Mode of injury, clinicoradiologic features, management, and outcomes were analyzed. The Glasgow Outcome Scale (GOS) was used to assess outcome. RESULTS: Our cohort was predominately male (82%). The mean patient age was 72.1 years (range, 65-97 years), and 20 were age ≥75 years. Head injuries (HIs) were mild in 37 patients, moderate in 18, and severe in 18. The majority of injuries were contusions. Fifty-five patients (75%) were managed conservatively, and 18 (25%) underwent surgery. There were 7 deaths (9.5%). The rate of poor outcome was 26% overall, and 45% in patients age ≥75 years. Poor outcome in severe HI was seen in 83% (15 of 18) of the entire cohort but in 100% (7 of 7) of 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 in patients with TBI. The benefit of surgery in these patients is unlikely, and surgery needs to weighed judiciously, keeping in mind the economics involved and the fate of caregivers, especially in developing countries.