title: Promising clinical outcome of elderly with TBI after modern neurointensive care.
abstract: BACKGROUND
  The increasing number of elderly patients with traumatic brain injury (TBI) leads to specific neurointensive care (NIC) challenges. Therefore, elderly subjects with TBI need to be further studied. In this study we evaluated the demographics, management and outcome of elderly TBI patients receiving modern NIC.
  
  
  METHODS
  Patients referred to our NIC unit between 2008 and 2010 were included. Patients were divided in two age groups, elderly (E) ≥65 years and younger (Y) 64-15 years. Parameters studied were the dominant finding on CT scans, neurological motor skills and consciousness, type of monitoring, neurosurgical procedures/treatments and Glasgow Outcome Scale Extended score at 6 months after injury.
  
  
  RESULTS
  Sixty-two E (22 %) and 222 Y (78 %) patients were included. Falls were more common in E (81 %) and vehicle accidents were more common in Y patients (37 %). Acute subdural hematoma was significantly more common in E (50 % of cases) compared to Y patients (18 %). Intracranial pressure was monitored in 44 % of E and 57 % of Y patients. Evacuation of significant mass lesions was performed more common in the E group. The NIC mortality was similar in both groups (4-6 %). Favorable outcome was observed in 72 % of Y and 51 % of E patients. At the time of follow-up 25 % of E and 7 % of Y patients had died.
  
  
  CONCLUSIONS
  The outcome of elderly patients with TBI was significantly worse than in younger patients, as expected. However, as much as 51 % of the elderly patients showed a favorable outcome after NIC. We believe that these results encourage modern NIC in elderly patients with TBI. We need to study how secondary brain injury mechanisms differ in the older patients and to identify specific outcome predictors for elderly patients with TBI.
authors.affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden.
authors.forename: Abraham
authors.initials: A
authors.lastname: Merzo
authors.affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden.
authors.forename: Samuel
authors.initials: S
authors.lastname: Lenell
authors.affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Nyholm
authors.affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Enblad
authors.affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden. anders.lewen@neuro.uu.se.
authors.forename: Anders
authors.identifier: http://orcid.org/0000-0003-4925-1348
authors.initials: A
authors.lastname: Lewén
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001930:Brain Injuries / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*
keywords: Elderly; Neurointensive care; Outcome; Secondary injury; Traumatic brain injury