Orlando Alessandro, Rubin Benjamin, Panchal Ripul, Tanner Allen, Hudson John, Harken Kyle, Madayag Robert, Berg Gina, Bar-Or David
Department of Trauma Research, Swedish Medical Center, Englewood, CO, United States.
Department of Trauma Research, Penrose Hospital, Colorado Springs, CO, United States.
Front Neurol. 2020 Jan 31;11:39. doi: 10.3389/fneur.2020.00039. eCollection 2020.
Advanced aged adults have the highest rate of traumatic brain injury (TBI) related hospital admissions, compared to younger age groups. Data were published in 2014 indicating differential injury and neurological responses to a TBI by age categories. In a recent article examining patients with mTBI and isolated subdural hematoma, it was found that older patients had a decreased risk of documented loss of consciousness (LOC). The primary objective was to determine the extent to which the odds of documented LOC changes with increasing age in a population of older adults suffering an isolated concussion and uncomplicated mTBI. This was a retrospective study utilizing 6 years (2010-2015) of National Trauma Data Bank data. This study included patients with (1) diagnosis of concussion; (2) positive or negative loss of consciousness; (3) loss of consciousness durations no longer than 59 min or undefined; (4) age ≥50 years; (5) had a "fall" mechanism of injury; and (6) a valid emergency department Glasgow coma scale 13-15. We excluded patients (1) with any intracranial hemorrhage or intracranial injury of other and unspecified nature; (2) skull fracture; (3) an injury severity scale score >17; (4) a concussion with "unspecified" LOC (ICD-9: 850.9). There were 7,466 patients included in the study; the median (IQR) age was 70 (60-80) years. The risk of documented LOC was 71% ( = 5,319). An 80-year-old had 72% decreased odds of having a documented LOC, compared to a 50-year-old (OR = 0.28, 99.5%CI [0.23-0.34], < 0.001). This association held when controlling for multiple demographic, comorbid, and clinical variables, and in sensitivity analyses. These nationwide data suggest that in patients aged ≥50 years, a significant inverse association exists between age and odds of documented LOC after sustaining a fall-related concussion. Additional studies are needed to validate these findings and to investigate the triad of age, documented LOC, and intracranial hemorrhage. Clinical diagnostic criteria relying on LOC might be at risk of being modified by the association between increasing age and decreasing odds of LOC.
与年轻人群相比，高龄成年人因创伤性脑损伤（TBI）入院的比例最高。2014年公布的数据表明，不同年龄组的TBI损伤及神经反应存在差异。在最近一篇研究轻度创伤性脑损伤（mTBI）和单纯性硬膜下血肿患者的文章中，发现老年患者记录在案的意识丧失（LOC）风险降低。主要目的是确定在遭受单纯性脑震荡和非复杂性mTBI的老年人群中，记录在案的LOC几率随年龄增长的变化程度。这是一项回顾性研究，利用了国家创伤数据库6年（2010 - 2015年）的数据。该研究纳入了符合以下条件的患者：（1）诊断为脑震荡；（2）意识丧失为阳性或阴性；（3）意识丧失持续时间不超过59分钟或未明确；（4）年龄≥50岁；（5）有“跌倒”致伤机制；（6）急诊科格拉斯哥昏迷量表评分为13 - 15分。我们排除了以下患者：（1）有任何颅内出血或其他性质未明确的颅内损伤；（2）颅骨骨折；（3）损伤严重程度量表评分>17分；（4）脑震荡伴“未明确”的LOC（国际疾病分类第九版：850.9）。该研究共纳入7466例患者；年龄中位数（四分位间距）为70（60 - 80）岁。记录在案的LOC风险为71%（n = 5319）。与50岁患者相比，80岁患者记录在案的LOC几率降低了72%（比值比 = 0.28，99.5%置信区间[0.23 - 0.34]，P < 0.001）。在控制了多个人口统计学、合并症和临床变量以及敏感性分析中，这种关联依然成立。这些全国性数据表明，在年龄≥50岁的患者中，在遭受与跌倒相关的脑震荡后，年龄与记录在案的LOC几率之间存在显著的负相关。需要进一步研究来验证这些发现，并调查年龄、记录在案的LOC和颅内出血之间的关系。依赖LOC的临床诊断标准可能会因年龄增长与LOC几率降低之间的关联而面临被修改的风险。
