Department of Neuroscience/Neurosurgery, Section of Neurosurgery, Uppsala University Hospital, Uppsala University, SE-751 85, Uppsala, Sweden.
Acta Neurochir (Wien). 2019 Jun;161(6):1243-1254. doi: 10.1007/s00701-019-03893-6. Epub 2019 Apr 13.
The probability of favorable outcome after traumatic brain injury (TBI) decreases with age. Elderly, ≥ 60 years, are an increasing part of our population. Recent studies have shown an increase of favorable outcome in elderly over time. However, the optimal patient selection and neurointensive care (NIC) treatments may differ in the elderly and the young. The aims of this study were to examine outcome in a larger group of elderly TBI patients receiving NIC and to identify demographic and treatment related prognostic factors.
Patients with TBI ≥ 60 years receiving NIC at our department between 2008 and 2014 were included. Demographics, co-morbidity, admission characteristics, and type of treatments were collected. Clinical outcome at around 6 months was assessed. Potential prognostic factors were included in univariate and multivariate regression analysis with favorable outcome as dependent variable.
Two hundred twenty patients with mean age 70 years (median 69; range 60-87) were studied. Overall, favorable outcome was 46% (Extended Glasgow Outcome Scale (GOSE) 5-8), unfavorable outcome 27% (GOSE 2-4), and mortality 27% (GOSE 1). Significant independent negative prognostic variables were high age (p < 0.05), multiple injuries (p < 0.05), GCS M ≤ 3 on admission (p < 0.05), and mechanical ventilation (p < 0.001).
Overall, the elderly TBI patients > 60 years receiving modern NIC in this study had a fair chance of favorable outcome without large risks for severe deficits and vegetative state, also in patients over 75 years of age. High age, multiple injuries, GCS M ≤ 3 on admission, and mechanical ventilation proved to be independent negative prognostic factors. The results underline that a selected group of elderly with TBI should have access to NIC.
创伤性脑损伤（TBI）后预后良好的概率随年龄增长而降低。≥60 岁的老年人是我们人口增长的一部分。最近的研究表明，老年人的预后随时间推移而增加。然而，老年人和年轻人的最佳患者选择和神经重症监护（NIC）治疗可能不同。本研究旨在检查更大数量接受 NIC 的老年 TBI 患者的结果，并确定与人口统计学和治疗相关的预后因素。
纳入 2008 年至 2014 年期间在我院接受 NIC 的≥60 岁 TBI 患者。收集人口统计学、合并症、入院特征和治疗类型。大约 6 个月时评估临床结局。将潜在的预后因素纳入单变量和多变量回归分析，以良好结局为因变量。
研究了 220 名平均年龄 70 岁（中位数 69；范围 60-87）的患者。总体而言，良好结局为 46%（扩展格拉斯哥结局量表（GOSE）5-8），不良结局为 27%（GOSE 2-4），死亡率为 27%（GOSE 1）。显著的独立负预后因素是高龄（p<0.05）、多发伤（p<0.05）、入院时 GCS M≤3（p<0.05）和机械通气（p<0.001）。
总体而言，本研究中接受现代 NIC 的>60 岁老年 TBI 患者有良好的良好结局机会，且没有严重缺陷和植物状态的大风险，即使在 75 岁以上的患者中也是如此。高龄、多发伤、入院时 GCS M≤3 和机械通气证明是独立的负预后因素。结果强调，应让具有 TBI 的选定老年患者能够获得 NIC。
