高龄单纯轻度外伤性脑损伤伴幕上硬膜下血肿患者的高长期死亡率：神经外科的髋关节骨折？

High Long-Term Mortality Rate in Elderly Patients with Mild Traumatic Brain Injury and Subdural Hematoma due to Ground-Level Fall: Neurosurgery's Hip Fracture?

机构信息

Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.

Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA; Department of Neurology, University of Virginia, Charlottesville, Virginia, USA.

出版信息

World Neurosurg. 2022 Nov;167:e1122-e1127. doi: 10.1016/j.wneu.2022.08.140. Epub 2022 Sep 6.

DOI:10.1016/j.wneu.2022.08.140

PMID:36075357

Abstract

BACKGROUND

Moderate-to-severe traumatic brain injury (TBI) is a major source of morbidity and mortality in elderly patients. Little is known about long-term mortality in elderly patients following mild, nonfatal TBI and how the injury mechanism predicts survival. This study aimed to compare long-term mortality in elderly patients with mild TBI and traumatic subdural hematoma (tSDH) due to ground-level fall (GLF) versus those with TBI and tSDH due to another cause (i.e., non-ground-level fall [nGLF]).

METHODS

This retrospective study comprised 288 patients ≥60 years old from a single Level I trauma center with tSDH and Glasgow Coma Scale scores 13-15.

RESULTS

Median follow-up after initial TBI presentation was 2.9 years for the GLF group and 2.4 years for the nGLF group. During follow-up, 98 patients died, and median survival for all elderly patients with mild TBI and tSDH was 4.6 years. The GLF group had a higher mortality rate than the nGLF group, with 93 patients in GLF group dying during follow-up compared with 5 in nGLF group (P < 0.0001). The annual death rate for patients in the GLF group was 12.5% per year. For patients 60-69 years old, 39% in GLF group died compared with 4% in nGLF group during follow-up (P = 0.0002). Likewise, for patients 70-79 years old, 29% in GLF group died compared with 7% in nGLF group (P = 0.021). Finally, 56% of patients >80 years old in GLF group compared with 18% in nGLF group (P = 0.11).

CONCLUSIONS

Elderly patients with mild TBI and tSDH due to GLF have significantly higher long-term mortality than patients with injuries due to nGLF.

摘要

背景

中重度创伤性脑损伤（TBI）是老年患者发病率和死亡率的主要原因。对于轻度、非致命性 TBI 后老年患者的长期死亡率以及损伤机制如何预测生存率，目前知之甚少。本研究旨在比较因地面坠落（GLF）导致轻度 TBI 和创伤性硬脑膜下血肿（tSDH）与因其他原因（即非地面坠落[nGLF]）导致 TBI 和 tSDH 的老年患者的长期死亡率。

方法

本回顾性研究纳入了来自单一一级创伤中心的 288 名年龄≥60 岁、tSDH 和格拉斯哥昏迷量表评分 13-15 的患者。

结果

GLF 组中位随访时间为初始 TBI 表现后 2.9 年，nGLF 组为 2.4 年。在随访期间，98 例患者死亡，所有轻度 TBI 和 tSDH 老年患者的中位生存时间为 4.6 年。GLF 组的死亡率高于 nGLF 组，GLF 组中有 93 例患者在随访期间死亡，而 nGLF 组仅有 5 例（P<0.0001）。GLF 组患者的年死亡率为 12.5%。对于 60-69 岁的患者，GLF 组有 39%的患者在随访期间死亡，而 nGLF 组仅有 4%（P<0.0002）。同样，对于 70-79 岁的患者，GLF 组有 29%的患者在随访期间死亡，而 nGLF 组有 7%（P=0.021）。最后，80 岁以上的患者中，GLF 组有 56%的患者死亡，而 nGLF 组有 18%（P=0.11）。