Traumatic brain injury in the elderly: a significant phenomenon.
BACKGROUND
Traumatic brain injury (TBI) in the elderly is becoming an increasingly frequent phenomenon. Studies have mainly analyzed the influence of age as a continuous variable and have not specifically looked at geriatric patients as a group. The aim of this study is to map the magnitude and characteristics of geriatric TBI and to identify factors contributing to their poorer outcome.


METHODS
Based on the ICD-9 register of the University Hospitals Leuven demographic and clinical variables of TBI were analyzed (2002-2008). The influence of older age on physiological variables was assessed using the Brain-IT database.


RESULTS
The elderly (aged ≥65 years) accounted for 38.2% of non-concussion TBI and 32.6% of ICU admissions, representing the largest age group. The elderly had a significantly lower ICP (median 10.06 mmHg versus median 14.52 mmHg; p = 0.048), but no difference in their measure of autoregulation (daily mABP/ICP correlation coefficient) compared with 20-35 year-olds. TBI was caused by a fall in 78.9% of elderly patients and 42.3% suffered a mass lesion. 72.1% had cardiovascular comorbidity. Complications did not differ from their younger counterparts.


CONCLUSIONS
Geriatric TBI is a significant phenomenon. Poorer outcomes are not yet sufficiently explained by physiological monitoring data, but reduced vascular versatility is likely to contribute. More research is needed in order to develop specific management protocols.
University Hospitals Leuven, Belgium. bart.depreitere@uzleuven.be
B
B
Depreitere
G
G
Meyfroidt
G
G
Roosen
J
J
Ceuppens
F Guiza
FG
Grandas
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D001794:Blood Pressure; D001930:Brain Injuries / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005853:Geriatrics; D023261:Glasgow Outcome Scale; D006801:Humans; D038801:International Classification of Diseases; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult