Outcome of moderate and severe traumatic brain injury amongst the elderly in Singapore.
BACKGROUND
In line with other established protocols, our unit has instituted a standardised protocol for the management of moderate and severe traumatic brain injury since 1996 in our neurointensive care unit.


METHODS
We reviewed the outcomes, at 6 months' post-injury, in an elderly group aged > or = 64 years (73.86 +/- 8.0 years) and compared them to a younger group aged 20 to 40 years (29.2 +/- 5.7 years) in a cohort of 324 patients. Outcome was dichotomised as favourable (mild and moderate disability but independent; Glasgow Outcome Score [GOS] 4 and 5), unfavourable (severe disability and persistent vegetative state; GOS 2 and 3) and death (GOS 1).


RESULTS
In the elderly group, the mortality (55.4%) was slightly more than double that of the younger group (20.9%); 21.5% had an unfavourable outcome (14.2% in the younger group) and only 23% had a favourable outcome (compared to 64.9% in the younger group). The final outcomes were significantly worse in all levels in the elderly group. This was in spite of data showing that the mechanism of injury was of a higher impact in the younger group, with a higher incidence of polytrauma and cervical spine injury. On admission, the mean Glasgow Coma Score (GCS) was 8.3 +/- 3.91 for the elderly group and 8.59 +/- 4.05 for the younger group (P = 0.763). Computed tomography scan showed that the elderly had a higher incidence of mass lesions (extradural haematoma and subdural haematoma) and traumatic subarachnoid haemorrhage. A subgroup (29.2%) of elderly patients had no surgical intervention based on poor clinical/neurological status, premorbid functional status and pre-existing medical conditions, with their family's consent. The GCS of < or = 8, on admission, was significant (P <0.001) in predicting mortality in the elderly. In the elderly group, the female gender had a higher mortality rate (70.4%) than the males (44.7%) (P = 0.19).


CONCLUSIONS
Age must be considered an independent factor in outcome prediction in the elderly with moderate and severe traumatic brain injury. A more conservative approach in the management of an elderly patient with severe head injury may be reasonable given its dismal outcomes after careful dialogue with the relatives.
Department of Neurosurgery, National Neuroscience Institute, Singapore.
B K
BK
Gan
J H G
JH
Lim
I H B
IH
Ng
D000328:Adult; D001930:Brain Injuries / Q000628:therapy*; D002772:Cholera Toxin; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006407:Hematoma, Epidural, Cranial / Q000628:therapy; D006408:Hematoma, Subdural / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012846:Singapore; D016896:Treatment Outcome
D002772:Cholera Toxin