Indian Journal of Neurotrauma 2011; 08(02): 77-82
DOI: 10.1016/S0973-0508(11)80004-3
Original article
Thieme Medical and Scientific Publishers Private Ltd.

Severe head injury in the elderly: risk factor assessment and outcome analysis in a series of 100 consecutive patients at a Level 1 trauma centre

Sachin A Borkar
,
Sumit Sinha
,
Deepak Agrawal
,
Guru Dutt Satyarthee
,
Deepak Gupta
,
Ashok Kumar Mahapatra

Subject Editor:
Further Information

Publication History

Publication Date:
05 April 2017 (online)

Abstract

Incidence of head injuries is rising all over the world. Very few studies have been performed regarding severe head injury in the elderly. We aimed to study the epidemiology, mode of injury, clinical profile,management, complications and outcome in severe head injury occurring in the elderly (age e"60years). One hundred consecutive patients of severe head injury(GCSd" 8) admitted at a Level 1 trauma centre from 2006 through 2008 were retrospectively analysed. The cases were reviewed in the light of epidemiology, clinico-radiological findings, associated injuries, comorbidities, surgical intervention, post-operative complications and long-term outcome. Mean age was 63.5 years± 4.64(60-85 years, 74%male). Road traffic accident was the most common mode of injury(72%). Median GCS at admission was 5(range-3-8). CT scan revealed acute subdural hematoma in 53 (53%) patients, cerebral contusion in 53, SAH in 20, extradura hematoma in 10 and diffuse axonal injury in 11 patients. Associated comorbidities included DM in 17%, CAD in 10%, hypertension in 9%, alcoholic liver disease in 8%. Associated spinal injury was observed in 10%, abdominal solid organ injury in 5, pneumothorax in 6 patients. Eighty two patients underwent operative intervention. Remaining 18 patients were managed conservatively. Forty patients(40%) developed ventilator —associated pneumonia (VAP), meningitis(16%), septicemia(20%), coagulopathy(11%) and multi-organ dysfunction syndrome (MODS)(20%). Overall mortality was 70%. Follow up was available for 24 out of the 30 survivors (80%). Median GOS score for those patients who survived was 4(3–5) at 6m follow-up period was positively correlated with pre-admission GCS score (Correlation coefficient +0.78). Mean time interval from injury to intervention, associated comorbidities, associated spinal, orthopaedic and abdominal injury; traumatic SAH on CT head all were more common in patients with ultimate unfavourable outcome as compared to patients who survived and this difference was statistically significant (p value<0.05). Severe head injury in elderly carries a high mortality owing to associated comorbidities. Pre-admission GCS score bears a positive correlation to GOS score at 6 months followup. VAP with resultant septicemia is the foremost post-operative cause of death in severe head injury in the elderly. In this regard, there is a need for an integrated multi-modality multidepartmental dedicated teamwork.

 
  • References

  • 1 Park K. Preventive medicine in obstetrics, paediatrics and geriatrics. Text book of Preventive and Social Medicine, 18eds. 2005:434.
  • 2 Hukkelhoven CW, Steyerberg EW, Rampen AJ. et al Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg 2003; 99: 666-673
  • 3 Hanif S, Abodunde O, Ali Z, Pidgeon C. Age related outcome in acute subdural haematoma following traumatic head injury. Ir Med J 2009; 102: 255-257
  • 4 Servadei F. Prognostic factors in severely head injured adult patients with epidural haematoma's. Acta Neurochir (Wien) 1997; 139: 273-278
  • 5 Gómez PA, Lobato RD, Boto GR, De la Lama A, lez PJ, de la Cruz J. Age and outcome after severe head injury. Acta Neurochir (Wien) 2000; 142: 373-380
  • 6 Sinha VD, Gupta V, Singh DK, Chopra S, Gupta P, Bagaria H. Geriatric head injuries — Experience and expectations. Ind J Neurotrauma (IJNT) 2008; 05: 69-673
  • 7 Mitra B, Cameron PA, Gabbe BJ, Rosenfeld JV, Kavar B. Management and hospital outcome of the severely head injured elderly patient. ANZ J Surg 2008; 78: 588-592
  • 8 Sinha AK, Mahapatra AK, Bhatia R. Acute head injury in elders. JANE 2000; 04: 27-233
  • 9 Galbraith SL. Delayed and mis-diagnosis in acute traumatic intracranial haematoma. Br Med J 1976; i: 1438-1439
  • 10 Teasdale G, Skene A, Spiegelhalter D, Murray L. Age, severity, and outcome of head injury. In: Grossman R G, Gildenberg P L. (Eds) Head injury: basic and clinical aspects. Raven Press; New York: 1982: 213-220
  • 11 Roy CW, Pentland B, Miller JD. The causes and consequences of minor head injury in the elderly. Injury 1986; 17: 220-223
  • 12 Rouk LE AA, Nadvi SS. Acute extradural haematoma in the elderly. Br J Neurosurg 2007; 21: 16-20
  • 13 Cummings JL, Benson DF. Dementia: A Clinical Approach. 2nd edn Butterworth- Heinemann; Boston: 1992
  • 14 Cifu DX, Kreutzer JS, Marwits JH. et al Functional outcomes of older adults with traumatic brain injuries: a prospective multicenter analysis. Arch Phys Rehabil 1996; 77: 883-888
  • 15 Rothweiler B, Temkin NR, Dikmen SS. Aging Effect on Psychosocial Outcome in Traumatic Brain Injury. Arch Phys Rehabil 1998; 79: 881-887
  • 16 Ritchie PD, Cameron PA, Ugoni AM. A study of the functional outcome and mortality in elderly patients with head injuries. J Clin Neurosci 2000; 07: 301-304