Acute Traumatic Brain Injury: Mortality in the Elderly.
OBJECTIVE
Despite recent progress, prognosis for the elderly (defined as aged ≥70 years) afflicted by traumatic brain injury (TBI) is unfavorable and surgical intervention remains controversial. Research during the past decade on the mortality rates or prognostic factors for survival in the elderly is limited.


METHODS
We analyzed 97 patients aged ≥70 years who were treated surgically for closed TBI at our neurosurgical unit between January 1, 2003 and December 31, 2012. In addition, we analyzed 22 patients aged ≥70 years who had sustained a closed TBI and on whom no neurosurgical intervention was performed. Outcome in both groups was measured as 30-, 90- and 180-day mortality.


RESULTS
Surgically treated patients: median age, 76 years' 30-day overall mortality rate, 36%. Higher mortality was seen with lower level of consciousness, high energy trauma, one pupil fixed and dilated, and more extensive intracranial pathology. Presence of warfarin, more advanced age, or degree of midline shift were not associated with worsened outcome. Patients not treated neurosurgically: median age. 81.5 years; 30-day overall mortality rate, 23%. Mortality for patients with Glasgow coma scale (GCS) 10-15 was 6%, GCS 6-9 67%, and GCS 3-5 100%.


CONCLUSIONS
Selected patients aged ≥70 years can benefit from surgical intervention for closed TBI. Level of consciousness, radiologic type of injury, mechanism of injury, and pupil abnormalities should be carefully evaluated. There also seems to exist a group of patients in whom surgical intervention offers little benefit, as mortality rate is low without surgical intervention.
Department of Neurosurgery, Lund University Hospital, Lund, Sweden. Electronic address: Erik.Herou@skane.se.
Erik
E
Herou
Department of Neurosurgery, Lund University Hospital, Lund, Sweden.
Bertil
B
Romner
Department of Neurosurgery, Lund University Hospital, Lund, Sweden.
Gregor
G
Tomasevic
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D003399:Craniotomy; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D006408:Hematoma, Subdural / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D014859:Warfarin
Craniotomy; Elderly; Head injury; TBI; Trauma; aSDH