Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-Ku, Tokyo, 130-8575, Japan.
Acta Neurochir (Wien). 2024 Oct 10;166(1):403. doi: 10.1007/s00701-024-06301-w.
Dementia is a common comorbidity in older patients with traumatic brain injury (TBI), potentially affecting their care processes and outcomes. However, the impact of pre-existing dementia on TBI remains unclear as research on TBI often excludes older adults with comorbidities. This study aimed to investigate the association between pre-existing dementia and outcomes in older patients admitted to hospitals after TBI.
This observational study included patients aged ≥ 65 years with TBI who were identified from the Japan Trauma Data Bank between January 1, 2019, and December 31, 2021. Associations between pre-existing dementia and outcomes were assessed using multivariable logistic regression analysis. The primary outcome was survival at discharge. Secondary outcomes were neurosurgical interventions and discharge to home.
In total, 16,270 patients from 175 hospitals were analyzed. Of these, 1,750 (10.8%) had pre-existing dementia, and 13,520 (83.1%) survived to discharge. No significant association was observed between pre-existing dementia and neurosurgical interventions and survival at discharge. In contrast, pre-existing dementia was associated with a significantly lower likelihood of being discharged to home. Subgroup analysis revealed interactions between pre-existing dementia and the subgroups, showing adverse impact in relatively younger patients and those without severe head injury.
Patients with pre-existing dementia had similar chances for neurosurgical intervention and survival at discharge than their counterparts without dementia. However, pre-existing dementia was associated with a significantly lower likelihood of being discharged to home, especially in relatively younger patients and those without severe head injury. Therefore, recognizing the risks within this population and taking measures to facilitate social reintegration is necessary.
痴呆是老年创伤性脑损伤（TBI）患者常见的合并症，可能会影响他们的治疗过程和结局。然而，既往痴呆对 TBI 的影响尚不清楚，因为 TBI 的研究通常排除了患有合并症的老年人。本研究旨在调查 TBI 后住院的老年患者中既往痴呆与结局之间的关系。
本观察性研究纳入了 2019 年 1 月 1 日至 2021 年 12 月 31 日期间从日本创伤数据库中确定的年龄≥65 岁的 TBI 患者。使用多变量逻辑回归分析评估既往痴呆与结局之间的关联。主要结局为出院时存活。次要结局为神经外科干预和出院回家。
共分析了来自 175 家医院的 16270 名患者。其中，1750 名（10.8%）有既往痴呆，13520 名（83.1%）存活至出院。既往痴呆与神经外科干预和出院时存活无显著关联。相反，既往痴呆与出院回家的可能性显著降低相关。亚组分析显示，既往痴呆与亚组之间存在交互作用，在相对年轻的患者和无严重头部损伤的患者中表现出不利影响。
与无痴呆的患者相比，既往痴呆患者接受神经外科干预和出院时存活的可能性相似。然而，既往痴呆与出院回家的可能性显著降低相关，尤其是在相对年轻的患者和无严重头部损伤的患者中。因此，有必要认识到该人群的风险，并采取措施促进其社会重新融入。
