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Published on: January 30, 2018
CT-positive traumatic brain injury in patients ≥ 80 years: mortality and 6-months functional outcome
Mads Aarhus1,2, D F Netteland3, C Tverdal3
1Department of Neurosurgery, Oslo University Hospital, Pb 4956 Nydalen, 0424, Oslo, Norway. madaar@ous-hf.no.
Purpose:
Traumatic brain injury (TBI) in patients ≥ 80 years poses major clinical challenges, with limited evidence to guide neurosurgical decision-making. We evaluated mortality, functional outcomes, and prognostic factors in patients undergoing neurosurgical versus conservative management.
Methods:
This cohort study included patients ≥ 80 years with imaging-verified TBI treated at a tertiary trauma centre. Demographics, injury characteristics, treatment, mortality, and 6-month outcomes were collected. Favourable outcome was defined as Glasgow Outcome Scale 4 and 5. Multivariable logistic regression identified predictors of mortality and unfavourable outcome, and Cox regression assessed 30, 180, and 365 days mortality.
Results:
A total of 608 patients (median age 85.8 years; 52% female) were included; 84 (14%) underwent neurosurgical intervention. Thirty-day and one-year mortality were 24% and 42%, respectively. Neurosurgical intervention was associated with reduced 30-day mortality (HR 0.46, 95% CI 0.28-0.76; p = 0.002) but not one-year mortality (HR 0.84, 95% CI 0.63-1.12; p = 0.23). Favourable 6-month outcome occurred in 29% of patients having intervention versus 34% of conservatively managed patients (p = 0.439). Increasing age, higher ASA class, dependent preinjury living, and injury severity were independently associated with unfavourable outcome. Acute craniotomy was associated with higher mortality and unfavourable outcome, whereas later trephination for subsequent chronic subdural haematoma was associated with lower mortality (5%) and better outcomes. Guideline adherence for ICP monitoring was 54%.
Conclusion:
In patients ≥ 80 years with TBI, neurosurgical intervention was associated with reduced early mortality but was not associated with improved 365-days survival or functional outcome at 6 months. Outcomes were largely determined by preinjury status and injury severity. These findings suggest selective surgical decision-making, with consideration of baseline function, comorbidity, and patient-centred goals of care.
