title: Association Between Comorbidities, Nutritional Status, and Anticlotting Drugs and Neurologic Outcomes in Geriatric Patients with Traumatic Brain Injury.
abstract: BACKGROUND
  Several studies using trauma data banks and registers showed that age, Glasgow Coma Scale (GCS), Injury Severity Score, and intraventricular hemorrhage were independent factors for neurologic outcomes in geriatric patients with traumatic brain injury (TBI). However, these analyses did not comprehensively evaluate factors particularly associated with geriatric patients. We aimed to identify factors particularly associated with geriatric patients that affect neurologic outcomes in TBI.
  
  
  METHODS
  Patients aged ≥65 years who were hospitalized consecutively in Kagawa University Hospital with severe TBI between 1 January 2008 and 31 October 2015 were retrospectively reviewed. We evaluated background factors particularly associated with geriatric patients, including comorbidities (Charlson Comorbidity Index [CCI]), nutritional status (serum albumin level), and presence/absence of antiplatelet and anticoagulant drugs, in addition to baseline characteristics. Multivariate analyses were performed to identify independent predictors of unfavorable neurologic outcomes (UO), as defined as a Glasgow Outcome Scale score of 1-3 at discharge from hospital. The association between CCI and UO was evaluated in a subgroup analysis.
  
  
  RESULTS
  UO occurred in 65.0% of 140 patients. Multivariate analyses showed that the CCI (odds ratio, 1.91; 95% confidence interval, 1.21-3.29; P = 0.011), age, and GCS were independent predictors of UO. In subgroup analyses of patients with an initial GCS score of 13-15, the rate of UO significantly increased with CCI score (CCI 0, 35.5%; CCI 1 or 2, 39.4%; CCI >2, 83.3%; P < 0.01).
  
  
  CONCLUSIONS
  CCI was an independent predictor of UO in geriatric patients with severe TBI.
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Okazaki
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan. Electronic address: hifumitoru@gmail.com.
authors.forename: Toru
authors.initials: T
authors.lastname: Hifumi
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kawakita
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Nakashima
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Matsumoto
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Shishido
authors.affiliation: Department of Neurosurgery, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Daiske
authors.initials: D
authors.lastname: Ogawa
authors.affiliation: Department of Neurosurgery, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Okauchi
authors.affiliation: Department of Neurosurgery, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shindo
authors.affiliation: Department of Neurosurgery, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kawanishi
authors.affiliation: Department of Neurosurgery, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamiya
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Ikenobe, Miki, Kita, Kagawa, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kuroda
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001927:Brain Diseases / Q000401:mortality*; D000070642:Brain Injuries, Traumatic / Q000401:mortality*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009422:Nervous System Diseases / Q000401:mortality*; D009752:Nutritional Status; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000925:Anticoagulants
keywords: Charlson Comorbidity Index; Geriatric; Neurologic outcome; Traumatic brain injury