Clinical article: mortality associated with severe head injury in the elderly.
BACKGROUND
Age is an important factor in determining prognosis following severe head injury (SHI), although mortality in patients > or =65 years is poorly reported. The aim of this study was to document mortality in patients with SHI > or =65 years.


METHODS
A retrospective analysis of prospectively collected data from the TARN (Trauma Audit and Research Network) database (1996-2004) was performed. Six hundred and sixty-nine patients aged > or =65 with a GCS <9 after a head injury were identified, and mortality at 3 months was recorded.


RESULTS
Mortality was 71% in 65- to 70-year-old patients (n = 137) (CI, 64-79), 75% for patients aged 70-75 years (n = 147) (CI, 68-82), 85% in patients aged 75-80 years (n = 160) (79-91), and 87% for patients >80 years (n = 225) (CI, 83-91). Mortality for all patients > or =65 years with a GCS 3-5 was >80%. A better outcome was observed in patients with a GCS = 6-8 [65-70 years, 47% (CI, 30-64); 70-75 years, 56% (CI, 43-69); 75-80 years, 73% (CI, 62-85); >80 years, 79% (CI, 70-87)].


CONCLUSIONS
SHI-related mortality continues to increase with age. Overall, these data support a conservative approach to the severely head-injured elderly patient; however, patients presenting with a GCS = 6-8 and below the age of 75 may represent a group where more aggressive therapy may be indicated.
Patel
H C
HC
Department of Neurosurgery, Hope Hospital, Salford, M6 8HD, UK.
Bouamra
Omar
O
Woodford
Maralyn
M
Yates
David W
DW
Lecky
Fiona E
FE
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy; D002985:Clinical Protocols / Q000592:standards; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014218:Triage / Q000592:standards; D006113:United Kingdom / Q000453:epidemiology