Prasad G Lakshmi, Anmol N, Menon Girish R
Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, India.
Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, India.
World Neurosurg. 2018 Mar;111:e228-e234. doi: 10.1016/j.wneu.2017.12.034. Epub 2017 Dec 16.
The growing elderly population has contributed to an increasing incidence of traumatic brain injury (TBI) in this cohort worldwide. Here we describe our institutional experience in the management of TBI in elderly Indian patients.
This was a 3-year retrospective analysis of 73 consecutive patients age ≥65 years admitted to our university hospital with TBI. Exclusion criteria included a history of concussion injury, chronic subdural hematoma (SDH), discharge against medical advice, and declared dead within 6 hours after arrival. Mode of injury, clinicoradiologic features, management, and outcomes were analyzed. The Glasgow Outcome Scale (GOS) was used to assess outcome.
Our cohort was predominately male (82%). The mean patient age was 72.1 years (range, 65-97 years), and 20 were age ≥75 years. Head injuries (HIs) were mild in 37 patients, moderate in 18, and severe in 18. The majority of injuries were contusions. Fifty-five patients (75%) were managed conservatively, and 18 (25%) underwent surgery. There were 7 deaths (9.5%). The rate of poor outcome was 26% overall, and 45% in patients age ≥75 years. Poor outcome in severe HI was seen in 83% (15 of 18) of the entire cohort but in 100% (7 of 7) of the very elderly patients. On univariate analysis, age ≥75 years, severe HI, acute SDH, and surgical management were significantly associated with poor outcome while acute SDH and surgical management were significant on multilogistic regression analysis.
Age ≥75 years, severe HI, and acute SDH are poor prognostic factors in patients with TBI. The benefit of surgery in these patients is unlikely, and surgery needs to weighed judiciously, keeping in mind the economics involved and the fate of caregivers, especially in developing countries.
全球老年人口的增长导致该群体中创伤性脑损伤（TBI）的发病率不断上升。在此，我们描述我们机构在印度老年TBI患者管理方面的经验。
这是一项对73例连续入住我校医院且年龄≥65岁的TBI患者进行的为期3年的回顾性分析。排除标准包括脑震荡损伤史、慢性硬膜下血肿（SDH）、违反医嘱出院以及到达后6小时内宣布死亡。分析损伤方式、临床放射学特征、管理方法及结果。采用格拉斯哥预后量表（GOS）评估预后。
我们的队列中男性占主导（82%）。患者平均年龄为72.1岁（范围为65 - 97岁），其中20例年龄≥75岁。37例患者头部损伤（HI）为轻度，18例为中度，18例为重度。大多数损伤为挫伤。55例患者（75%）接受保守治疗，18例（25%）接受手术治疗。有7例死亡（9.5%）。总体不良预后率为26%，年龄≥75岁的患者中为45%。在整个队列中，重度HI患者的不良预后率为83%（18例中的15例），但在高龄患者中为100%（7例中的7例）。单因素分析显示，年龄≥75岁、重度HI、急性SDH和手术治疗与不良预后显著相关，而多因素逻辑回归分析显示急性SDH和手术治疗具有显著性。
年龄≥75岁、重度HI和急性SDH是TBI患者不良的预后因素。这些患者手术获益不大，需要谨慎权衡手术与否，同时要考虑到经济因素以及护理人员的情况，尤其是在发展中国家。
