title: Outcome and surgical management for geriatric traumatic brain injury: analysis of 888 cases registered in the Japan Neurotrauma Data Bank.
abstract: OBJECTIVE
  As the aged population is rapidly growing globally, geriatric traumatic brain injury (TBI) becomes an increasing problem. There are higher mortality and poorer functional outcome in the geriatric TBI population (≥65 years) compared with younger groups despite neurosurgical interventions. Therefore, current treatment priorities and cost-effectiveness should be critically examined. We evaluated the benefit of surgical management in the elderly (≥65 years) after TBI.
  
  
  METHODS
  A total of 3194 patients with confirmed TBI were enrolled from 1998 to 2011, in the Japan Neurotrauma Data Bank. Retrospective analysis was conducted from the Japan Neurotrauma Data Bank on 888 (28%) patients (≥65 years) who did and did not undergo surgery. In particular, the effect of low Glasgow coma scale (GCS) (3-5) was compared with outcome with and without surgery.
  
  
  RESULTS
  Of all the patients 65 years of age and over, 478 (54%) were given surgical management (craniectomy, craniotomy, or burr-hole evacuation). This group of patients had significantly more favorable outcome at 6 months (18% vs. 7%) and less mortality (62% vs. 81%). However, within this surgical group, patients with initial GCS scores of 3-5 had significantly more unfavorable outcome (96% vs. 79%) and more mortality (87% vs. 57%) compared with those with GCS scores of 6-15.
  
  
  CONCLUSIONS
  We confirmed that age is a major determinant of outcome after TBI. In addition, we found that neurosurgical management is associated with the improvement of the prognosis and a decrease in the rate of mortality in geriatric TBI. However, surgical management was not shown to be an effective treatment in elderly patients with GCS scores of 3-5.
authors.affiliation: Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shimoda
authors.affiliation: Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan. Electronic address: maeda.takeshi@nihon-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tado
authors.affiliation: Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Yoshino
authors.affiliation: Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Katayama
authors.affiliation: Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: M Ross
authors.initials: MR
authors.lastname: Bullock
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000191:economics / Q000401:mortality / Q000601:surgery*; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007564:Japan; D008297:Male; D019635:Neurosurgical Procedures / Q000191:economics / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D016896:Treatment Outcome
keywords: Elderly; Surgical management; Traumatic brain injury