Acute Traumatic Brain Injury: Mortality in the Elderly.

Area of Science:

• Neurosurgery
• Traumatology
• Geriatrics

Background:

• Prognosis for elderly patients (≥70 years) with traumatic brain injury (TBI) is often poor.
• Surgical intervention for TBI in the elderly remains a controversial topic.
• Limited research exists on mortality rates and prognostic factors for elderly TBI survivors.

Purpose of the Study:

• To evaluate the outcomes of surgical intervention in elderly patients with closed TBI.
• To identify prognostic factors for survival in this patient group.
• To compare outcomes between surgically treated and non-surgically treated elderly TBI patients.

Main Methods:

• Retrospective analysis of 97 surgically treated and 22 non-surgically treated patients (≥70 years) with closed TBI.
• Data collected between January 1, 2003, and December 31, 2012.
• Outcome assessment based on 30-, 90-, and 180-day mortality rates.

Main Results:

• Surgically treated group (median age 76): 30-day mortality rate was 36%. Factors associated with higher mortality included decreased consciousness, high-energy trauma, pupillary abnormalities, and extensive intracranial pathology.
• Non-surgically treated group (median age 81.5): 30-day mortality rate was 23%. Mortality varied significantly with Glasgow Coma Scale (GCS) scores (6% for GCS 10-15, 67% for GCS 6-9, 100% for GCS 3-5).
• Warfarin use, advanced age, and degree of midline shift did not correlate with worse outcomes in the surgical group.

Conclusions:

• Selected elderly patients (≥70 years) with closed TBI can achieve benefits from surgical intervention.
• Careful assessment of neurological status (level of consciousness), injury characteristics (radiologic type, mechanism), and pupillary response is essential for treatment decisions.
• A subset of elderly patients with TBI may have a favorable prognosis without surgery, indicating that surgical intervention might offer limited benefit in such cases.