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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.
Keywords
brain injury - diffuse axonal injury - elderly - head injury - intracranial hematoma
