Hawley Carol, Sakr Magdy, Scapinello Sarah, Salvo Jesse, Wrenn Paul
Division of Mental Health and Wellbeing, Warwick Medical School, Coventry, UK.
Department of Emergency Medicine, University Hospital Coventry and Warwickshire, Coventry, UK.
Emerg Med J. 2017 Aug;34(8):509-516. doi: 10.1136/emermed-2016-206506. Epub 2017 Jan 4.
Our aim was to determine the incidence of traumatic brain injury (TBI) in older adults and investigate the relationship between injury characteristics and outcomes.
Retrospective analysis of prospectively collected data submitted to Trauma Audit and Research Network (TARN) database for a major trauma centre in the West Midlands, UK, from 2008 to 2014. The Mayo Scale was used to categorise TBI. All patients were aged ≥65 years and were admitted with head or brain injuries meeting TARN inclusion criteria: injury resulting in immediate admission to hospital for 3 days, admitted to a high dependency area or death following trauma. We determined age, gender, mechanism of injury, Injury Severity Score, presenting Glasgow Coma Scale (GCS) and Mayo Score, and the association of outcome (Glasgow Outcome Scale (GOS)) with age and clinical presentation.
4413 patients were admitted with trauma meeting TARN criteria: 1389 were ≥65 years and 45% (624) had TBI. For patients ≥65 years with TBI, mean age was 79 (range 65-99); 56% were men. Falls accounted for 85% of all TBIs. Most TBIs were moderate/severe (80%) by the Mayo criteria. Of the 279 patients with subdural haematoma, 28% had neurosurgery. Most patients survived TBI (78%); 57% had a good outcome on GOS at discharge (not requiring care package). Mortality was associated with increased age (17% in ages 65-74 years, 19% in 75-84 years, 30% in ≥85 years, p=0.03). Outcome was significantly associated with injury severity (p=0.0001).
Patients with TBI represented 45% of all trauma cases meeting TARN inclusion criteria. Falls at home accounted for most TBIs. Most had moderate/severe TBI, yet over half made a good recovery on GOS. Our data indicate that injury prevention initiatives should focus on home safety. Further research is needed to examine rehabilitation and follow-up after hospital discharge.
我们的目的是确定老年人创伤性脑损伤（TBI）的发生率，并研究损伤特征与预后之间的关系。
对2008年至2014年提交给英国西米德兰兹郡一家主要创伤中心的创伤审计与研究网络（TARN）数据库的前瞻性收集数据进行回顾性分析。采用梅奥量表对TBI进行分类。所有患者年龄≥65岁，因头部或脑部损伤入院，符合TARN纳入标准：受伤后立即入院3天，入住高依赖病房或创伤后死亡。我们确定了年龄、性别、损伤机制、损伤严重程度评分、入院时格拉斯哥昏迷量表（GCS）和梅奥评分，以及预后（格拉斯哥预后量表（GOS））与年龄和临床表现的关联。
4413例因创伤入院的患者符合TARN标准：1389例年龄≥65岁，其中45%（624例）患有TBI。年龄≥65岁的TBI患者平均年龄为79岁（范围65 - 99岁）；56%为男性。跌倒占所有TBI的85%。根据梅奥标准，大多数TBI为中度/重度（80%）。在279例硬膜下血肿患者中，28%接受了神经外科手术。大多数TBI患者存活（78%）；57%出院时GOS预后良好（不需要护理套餐）。死亡率与年龄增加相关（65 - 74岁为17%，75 - 84岁为19%，≥85岁为30%，p = 0.03）。预后与损伤严重程度显著相关（p = 0.0001）。
TBI患者占所有符合TARN纳入标准创伤病例的45%。家中跌倒占大多数TBI。大多数为中度/重度TBI，但超过一半患者GOS恢复良好。我们的数据表明，预防损伤措施应侧重于家庭安全。需要进一步研究以检查出院后的康复和随访情况。
