title: Elderly Patients with Severe Traumatic Brain Injury Could Benefit from Surgical Treatment.
abstract: OBJECTIVE
  In elderly patients with severe traumatic brain injury, the use of aggressive versus conservative management remains controversial. The aim of this study was to assess the outcome of surgical alternatives for treatment of severe traumatic intracranial hematoma in patients ≥65 years old and identify factors that may contribute to the outcome.
  
  
  METHODS
  This retrospective study included 112 patients with traumatic intracranial hematoma. Logistic regression analysis was used to identify independent predictors of unfavorable outcome. The Glasgow Outcome Scale was used to evaluate the outcome.
  
  
  RESULTS
  Surgery was performed in 70 (62.5%) patients ≥65 years old. A favorable outcome occurred in 33 (47.1%) surgical patients, and 23 (32.9%) surgical patients died. Patients who underwent surgery were less likely to have an unfavorable outcome (52.9% vs. 95.2%) and less likely to die (32.9% vs. 88.1%) at 6 months postinjury compared with patients treated conservatively. Multivariate logistic regression analysis revealed that lower Glasgow Coma Scale score (≤5) was a significant factor associated with unfavorable outcome (odds ratio [OR] = 18.7, 95% confidence interval [CI] = 5.2-95.5, P < 0.001) and mortality (OR = 10.7, 95% CI = 4.4-28.5, P < 0.001). However, neurosurgical intervention was a significant factor to negatively predict unfavorable outcome (OR = 0.03, 95% CI = 0.01-0.1, P < 0.001) and mortality (OR = 0.04, 95% CI = 0.01-0.1, P < 0.001).
  
  
  CONCLUSIONS
  This study showed that Glasgow Coma Scale score (≤5) was a major determinant of outcome in elderly patients with severe traumatic brain injury. However, surgical treatment reduced mortality and improved outcome in the elderly patients in this study.
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Xueyan
authors: X
authors: Wan
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Shengwen
authors: S
authors: Liu
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: wangsheng@tjh.tjmu.edu.cn.
authors: Sheng
authors: S
authors: Wang
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Suojun
authors: S
authors: Zhang
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Hongkuan
authors: H
authors: Yang
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Yibo
authors: Y
authors: Ou
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Min
authors: M
authors: Zhao
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Lubuulwa
authors: L
authors: James
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Kai
authors: K
authors: Shu
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Jincao
authors: J
authors: Chen
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Ting
authors: T
authors: Lei
mesh_terms: D000367:Age Factors; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000601:surgery; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Elderly; Prognosis; Surgery; Therapeutic approach; Traumatic brain injury