Department of Emergency and Critical Care Medicine, Nippon Medical School.
J Nippon Med Sch. 2021 Jun 30;88(3):194-203. doi: 10.1272/jnms.JNMS.2021_88-404. Epub 2020 Jun 30.
Because of the aging of the Japanese population, traumatic brain injuries (TBI) have increased in elderly adults. However, the effectiveness and prognosis of intensive treatment for geriatric TBI have not yet been determined. Thus, we used nationwide data from the Japan Neurotrauma Data Bank (JNTDB) projects to analyze prognostic factors for intensive and aggressive treatments.
We analyzed 1,879 geriatric TBI cases (age ≥65 years) registered in four JNTDB projects: Project 1998 (P1998) to Project 2015 (P2015). Clinical features, use of aggressive treatment, and 6-month outcomes on the Glasgow Outcome Scale (GOS) were compared among study projects. Logistic regression was used to identify prognostic factors in aggressively treated patients.
The percentage of geriatric TBI cases significantly increased with time-P1998: 30.1%; Project 2004 (P2004): 34.6%; Project 2009 (P2009): 43.9%; P2015: 53.6%, p<0.0001). Use of aggressive treatment also significantly increased, from 67.0% in P1998 to 69.3% in P2015 (p<0.0001). Less invasive methods, such as trepanation and normothermic targeted temperature management, were more often chosen for geriatric patients. These efforts resulted in a significant decrease in the 6-month mortality rate, from 76.2% in P1998 to 63.1% in P2015 (p=0.0003), although the percentage of severely disabled patients increased, from 8.9% in P1998 to 11.1% in P2015 (p=0.0003). Intraventricular hemorrhage was the factor most strongly associated with unfavorable 6-month outcomes (OR 3.79, 95% CI 1.78-8.06, p<0.0001).
Less invasive treatments reduced mortality in geriatric TBI but did not improve functional outcomes. Patient age was not the strongest prognostic factor; thus, physicians should consider characteristics other than age.
由于日本人口老龄化，老年创伤性脑损伤（TBI）有所增加。然而，针对老年 TBI 的强化治疗的效果和预后尚未确定。因此，我们使用日本神经创伤数据库（JNTDB）项目的全国性数据来分析强化和积极治疗的预后因素。
我们分析了在四个 JNTDB 项目（P1998 至 P2015 项目）中登记的 1879 例老年 TBI 病例（年龄≥65 岁）。比较了研究项目之间的临床特征、积极治疗的使用以及 6 个月时格拉斯哥结局量表（GOS）的结果。使用逻辑回归分析积极治疗患者的预后因素。
老年 TBI 病例的百分比随时间显著增加-P1998：30.1%；P2004 项目：34.6%；P2009 项目：43.9%；P2015 项目：53.6%，p<0.0001）。积极治疗的使用率也显著增加，从 P1998 年的 67.0%增加到 P2015 年的 69.3%（p<0.0001）。对于老年患者，更微创的方法，如颅骨钻孔和常温靶向体温管理，更常被选择。这些努力导致 6 个月死亡率显著下降，从 P1998 年的 76.2%下降到 P2015 年的 63.1%（p=0.0003），尽管严重残疾患者的比例从 P1998 年的 8.9%增加到 P2015 年的 11.1%（p=0.0003）。脑室内出血是与 6 个月不良结局最密切相关的因素（OR 3.79，95%CI 1.78-8.06，p<0.0001）。
微创治疗降低了老年 TBI 的死亡率，但并未改善功能结局。患者年龄不是最强的预后因素；因此，医生应考虑除年龄以外的其他特征。
