Ross Allen G P
Griffith Health Institute, Griffith University, Gold Coast Campus, Gold Coast, Australia.
J Med Case Rep. 2014 Dec 20;8:448. doi: 10.1186/1752-1947-8-448.
Severe traumatic brain injury is a major public health problem that accounts for one-third of all deaths due to trauma in the United States. This case report illustrates some of the challenges faced by the elderly in accessing essential emergency services for traumatic brain injury.
A 74-year-old Caucasian man presented with head trauma at his local acute care hospital (level III/IV) in Canada at 2:30 PM. He was triaged at 4:00 PM and was seen by the emergency room physician at 4:50 PM. His vital signs were normal, and his Glasgow Coma Scale score was 15/15 upon admission. A computed tomography-based diagnosis of acute subdural hematoma was subsequently made by a radiologist at 5:00 PM. A neurosurgical transfer was requested to the nearby tertiary trauma center (level I/II), but was initially refused by the neurosurgical resident on call. The patient's condition slowly deteriorated until he became unconscious at 7:45 PM. The patient was intubated and transferred to the neurosurgical unit at 8:34 PM. He was seen by a consultant neurosurgeon at 9:30 PM, but surgery (craniotomy) was deemed not viable, given the patient's age and the fact that his pupils were now fixed and dilated (Glasgow Coma Scale score 3/15). The patient was taken off life support at 1:00 AM the following morning and died shortly thereafter. The patient's family made a formal complaint, but the decision by an independent medical review panel was that "the patient's care was prudent, timely and professional."
Geriatric patients with severe head injury are less likely than their younger counterparts to be transferred to neurosurgical trauma centers. Protocol-driven care of the elderly can reduce mortality due to head trauma through the application of the Brain Trauma Foundation guidelines.
严重创伤性脑损伤是一个重大的公共卫生问题，在美国因创伤导致的死亡中占三分之一。本病例报告说明了老年人在获得创伤性脑损伤基本急救服务方面面临的一些挑战。
一名74岁的白人男性于下午2:30在加拿大当地的急症护理医院（三级/四级）因头部外伤就诊。他于下午4:00接受分诊，并于下午4:50由急诊室医生诊治。他入院时生命体征正常，格拉斯哥昏迷量表评分为15/15。放射科医生随后于下午5:00通过计算机断层扫描诊断为急性硬膜下血肿。请求将患者转至附近的三级创伤中心（一级/二级），但最初被值班的神经外科住院医生拒绝。患者的病情逐渐恶化，直到晚上7:45失去意识。患者于晚上8:34接受插管并转至神经外科病房。晚上九点半，一位神经外科顾问医生对他进行了检查，但鉴于患者的年龄以及他的瞳孔现已固定和散大（格拉斯哥昏迷量表评分为3/15），认为手术（开颅手术）不可行。第二天凌晨1:00，患者被撤掉生命维持设备，此后不久死亡。患者家属提出了正式投诉，但独立医学审查小组的决定是“对患者的护理谨慎、及时且专业”。
与年轻患者相比，老年重度颅脑损伤患者被转至神经外科创伤中心的可能性较小。通过应用脑创伤基金会指南，对老年人采用规范驱动的护理可以降低因头部创伤导致的死亡率。
