Management and hospital outcome of the severely head injured elderly patient.
BACKGROUND
Severe traumatic head injury in the elderly has been associated with poor outcomes. However, there is currently no consensus to direct management in these patients. This study outlines the demographics, injury characteristics, management and outcome of the elderly trauma patients with severe head injury across a defined population.


METHODS
A retrospective review of all elderly patients (age >64 years) with a Glasgow Coma Scale (GCS) score of 8 or less, and confirmed intracranial pathology or fractured skull, was undertaken over a period of 40 months from July 2001 to September 2005. Data on patient demographics, injury cause, presenting clinical features and interventions were collected. In-hospital mortality was used as the primary outcome.


RESULTS
There were 96 patients who met the inclusion criteria. One-third of the patients were managed palliatively, one-third supportively without surgery and another third underwent surgery. Overall mortality was 70.8% (n = 68). Older age and brainstem injuries were identified as independent predictors of mortality. Mortality was reported in all patients aged 85 years or older.


CONCLUSIONS
Although overall outcomes were poor, careful consideration should be given to active treatment as favourable outcomes were possible even in the presence of extremely low GCS scores. Prediction of outcome on the basis of age and anatomical diagnoses may help in this decision-making.
Mitra
Biswadev
B
Emergency & Trauma Centre, The Alfred Hospital, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. b.mitra@alfred.org.au
Cameron
Peter A
PA
Gabbe
Belinda J
BJ
Rosenfeld
Jeffrey V
JV
Kavar
Bhadrakant
B
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006259:Craniocerebral Trauma / Q000401:mortality* / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies