title: Mortality and One-Year Functional Outcome in Elderly and Very Old Patients with Severe Traumatic Brain Injuries: Observed and Predicted.
abstract: The aim of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) model based prediction, from the Medical Research Council (MRC). Methods. Prospective, national multicenter study including patients with severe TBI ≥ 65 years. Predicted mortality and outcome were calculated based on clinical information (CRASH basic) (age, GCS score, and pupil reactivity to light), as well as with additional CT findings (CRASH CT). Observed 14-day mortality and favorable/unfavorable outcome according to the Glasgow Outcome Scale at one year was compared to the predicted outcome according to the CRASH models. Results. 97 patients, mean age 75 (SD 7) years, 64% men, were included. Two patients were lost to follow-up; 48 died within 14 days. The predicted versus the observed odds ratio (OR) for mortality was 2.65. Unfavorable outcome (GOSE < 5) was observed at one year follow-up in 72% of patients. The CRASH models predicted unfavorable outcome in all patients. Conclusion. The CRASH model overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Oslo, Norway ; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Røe
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway ; Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Toril
authors.initials: T
authors.lastname: Skandsen
authors.affiliation: Faculty of Health Sciences, Institute of Clinical Medicine, University of Tromso, Norway ; Department of Neurosurgery, University Hospital of North Norway, Tromso, Norway.
authors.forename: Unn
authors.initials: U
authors.lastname: Manskow
authors.affiliation: Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
authors.forename: Tiina
authors.initials: T
authors.lastname: Ader
authors.affiliation: Faculty of Health Sciences, Institute of Clinical Medicine, University of Tromso, Norway ; Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway.
authors.forename: Audny
authors.initials: A
authors.lastname: Anke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D015599:Trauma Severity Indices