title: Traumatic brain injury in the elderly: considerations in a series of 103 patients older than 70.
abstract: OBJECTIVE
  Mortality and morbidity due to brain injury in the elderly population is a growing clinical problem: among older patients, those >70 years have a considerably higher risk both in terms of mortality and morbidity. Thereafter, the reasons influencing outcome have not been clearly examined: in the present study we addressed these questions considering the main clinical characteristics exerting a significant impact on the outcome of patients aged > 70, with emphasis for the severity of brain injury and anticoagulant (CAW) treatments.
  
  
  METHODS
  We performed a retrospective analysis of 103 consecutive isolated head injury patients older than 70, admitted at our Department in the period November 2004-November 2009. The clinical variables considered were as follow: age, sex, type of TBI, GCS, pre-TBI use of anti-coagulants (aspirin, warfarin, clopidogrel), INR at admission (INR values were subdivided in values >1.25 as at risk for hemorrhagic events and <1.25 as normal), initial CT scan classification looking at the presence of subarachnoid hemorrhage (t-SAH) or mass lesions; the main outcome measure was the Glasgow Outcome Scale.
  
  
  RESULTS
  The most frequent cause of TBI was accidental fall (65%): 39 were in CAW therapies and in 36 cases the cause of falling down injury was recorded due to a sincopal event (arterial hypotension, atrial fibrillation); in the older patients an accidental fall is significantly related to the TBI, while in the patients aged 70-75 years, TBI is related to a traffic accident (P=0.002). Moreover the cause of TBI correlates with the CAW treatment, the accidental fall being significantly more frequent in patients in CAW treatment (P=0.003). Overall mortality rate is significantly related to an elevated INR class, to presence of t-SAH (16/50 patients) and subdural hematoma (26/46).
  
  
  CONCLUSIONS
  The results of the present study show that in a population of patients aged > 70, TBI is a high risk event if patient has concurrent treatment with CAW therapies and if an accidental fall is the cause of TBI. In these cases the finding of t-SAH represents a high-risk parameter for mortality but not for morbidity.
authors.affiliation: Department of Neurosurgery, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy. neuro.gaetani@gmail.com
authors.forename: P
authors.initials: P
authors.lastname: Gaetani
authors.forename: M
authors.initials: M
authors.lastname: Revay
authors.forename: S
authors.initials: S
authors.lastname: Sciacca
authors.forename: F
authors.initials: F
authors.lastname: Pessina
authors.forename: E
authors.initials: E
authors.lastname: Aimar
authors.forename: D
authors.initials: D
authors.lastname: Levi
authors.forename: E
authors.initials: E
authors.lastname: Morenghi
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000401:mortality* / Q000601:surgery*; D000077144:Clopidogrel; D005260:Female; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D009017:Morbidity; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D020206:Subarachnoid Hemorrhage, Traumatic / Q000401:mortality / Q000601:surgery; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine