1Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto.
2Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre, University of Toronto.
Neurosurg Focus. 2020 Oct;49(4):E20. doi: 10.3171/2020.7.FOCUS20520.
The purpose of this study was to examine the population-based trends and factors associated with hospitalization of patients with traumatic brain injury (TBI) treated in the Emergency Department (ED) among those 65 years and older. The implications of these trends for neurosurgery and the broader society are discussed.
With a national, mandatory reporting system of ED visits, the authors used Poisson regression controlling for age and sex to analyze trends in fall-related TBI of those aged 65 years and older between 2002 and 2017.
The overall rate of ED visits for TBI increased by 78%-from 689.51 per 100,000 (95% CI 676.5-702.8) to 1229 per 100,000 (95% CI 1215-1243) between 2002 and 2017. Females consistently experienced higher rates of fall-related TBI than did males. All age groups 65 years and older experienced significant increases in fall-related TBI rate over the study period; however, the highest rates occurred among the oldest individuals (90+ and 85-89 years). The hospital admission rate increased with age and Charlson Comorbidity Index. Males experienced both a higher admission rate and a greater percentage change in admission rate than females.
Rates of ED visits for fall-related TBI, hospitalization, and in-ED mortality in those aged 65 years and older are increasing for both sexes. The increasing hospital admission rate is related to more advanced comorbidities, male sex, and increasing age. These findings have significant implications for neurosurgical resources; they emphasize that health professionals should work proactively with patients, families, and caregivers to clarify goals of care, and they also outline the need for more high-level and, preferably, randomized evidence to support outcomes-based decisions. Additionally, the findings highlight the urgent need for improved population-based measures for prevention in not only this age demographic but in younger ones, and the need for changes in the planning of health service delivery and long-term care.
本研究旨在探讨急诊科（ED）收治的 65 岁及以上创伤性脑损伤（TBI）患者住院的人群趋势和相关因素。讨论了这些趋势对神经外科和更广泛社会的影响。
利用全国强制性急诊就诊报告系统，作者采用泊松回归分析控制年龄和性别，分析了 2002 年至 2017 年间 65 岁及以上人群与跌倒相关的 TBI 的趋势。
总体上，ED 就诊治疗 TBI 的发生率增加了 78%-从 2002 年的 689.51/100,000（95%CI 676.5-702.8）增加到 2017 年的 1229/100,000（95%CI 1215-1243）。女性与跌倒相关的 TBI 发生率始终高于男性。所有 65 岁及以上年龄组在研究期间均经历了与跌倒相关的 TBI 发生率的显著增加；然而，最高的发生率出现在最年长的人群（90 岁及以上和 85-89 岁）。随着年龄和 Charlson 合并症指数的增加，住院率也随之增加。男性的入院率和入院率变化百分比均高于女性。
65 岁及以上人群因跌倒相关 TBI 就诊、住院和急诊死亡率都在增加，且两性均如此。住院率的增加与更严重的合并症、男性和年龄增长有关。这些发现对神经外科资源具有重要意义；它们强调卫生专业人员应积极与患者、家属和护理人员合作，明确治疗目标，还需要更多高水平的、最好是随机的证据来支持基于结果的决策。此外，这些发现还突出表明，不仅在这一年龄段，而且在年轻人群中，都迫切需要制定基于人群的预防措施，并需要改变卫生服务提供和长期护理的规划。
