title: Aggressive operative treatment of isolated blunt traumatic brain injury in the elderly is associated with favourable outcome.
abstract: Outcome after traumatic brain injury (TBI) in the elderly has not been fully elucidated. The present retrospective observational study investigates the age-dependent outcome of patients suffering from severe isolated TBI with regard to operative and non-operative treatment. Data were prospectively collected in the TraumaRegister DGU. Anonymous datasets of 8629 patients with isolated severe blunt TBI (AISHead≥3, AISBody≤1) documented from 2002 to 2011 were analysed. Patients were grouped according to age: 1-17, 18-59, 60-69, 70-79 and ≥80 years. Cranial fractures (44.8%) and subdural haematomas (42.6%) were the most common TBIs. Independent from the type of TBI the group of patients with operative treatment declined with rising age. Subgroup analysis of patients with critical TBI (AISHead=5) revealed standardised mortality ratios (SMRs) of 0.81 (95% CI 0.75-0.87) in case of operative treatment (n=1201) and 1.13 (95% CI 1.09-1.18) in case of non-operative treatment (n=1096). All age groups ≥60 years showed significantly reduced SMRs in case of operative treatment. Across all age groups the group of patients with low/moderate disability according to the GOS (4 or 5 points) was higher in case of operative treatment. Results of this retrospective observational study have to be interpreted cautiously. However, good outcome after TBI with severe space-occupying haemorrhage is more frequent in patients with operative treatment across all age groups. Age alone should not be the reason for limited care or denial of operative intervention.
authors: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany. Electronic address: sebastian.wutzler@kgu.de.
authors: Sebastian
authors: S
authors: Wutzler
authors: Institute for Research in Operative Medicine, University of Witten-Herdecke, Germany.
authors: Rolf
authors: R
authors: Lefering
authors: Institute for Research in Operative Medicine, University of Witten-Herdecke, Germany.
authors: Arasch
authors: A
authors: Wafaisade
authors: Institute for Research in Operative Medicine, University of Witten-Herdecke, Germany.
authors: Marc
authors: M
authors: Maegele
authors: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors: Thomas
authors: T
authors: Lustenberger
authors: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors: Felix
authors: F
authors: Walcher
authors: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors: Ingo
authors: I
authors: Marzi
authors: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors: Helmut
authors: H
authors: Laurer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006408:Hematoma, Subdural / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008020:Life Support Care / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*
keywords: Age; Decompressive craniectomy; Outcome; Surgery; Traumatic brain injury