Corriero Alberto, Fornaciari Anna, Terrazzino Samuel, Zangari Rossella, Izzi Antonio, Peluso Lorenzo, Savi Marzia, Faso Chiara, Cavallini Laura, Polato Martina, Vitali Eva, Schuind Sophie, Taccone Fabio Silvio, Bogossian Elisa Gouvêa
Department of Interdisciplinary Medicine-Intensive Care Unit Section, University of Bari Aldo Moro, Bari, Italy.
Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
Front Neurol. 2024 Nov 22;15:1471209. doi: 10.3389/fneur.2024.1471209. eCollection 2024.
Approximately one-third of trauma-related deaths are due to traumatic brain injury (TBI), particularly among young adults and elderly patients. Management strategies may vary across different age groups, potentially influencing short-term neurological outcomes. This study aims to investigate age-related disparities in treatment approaches and 3-month neurological outcomes among TBI patients.
We conducted a retrospective study on TBI patients requiring Intensive Care Unit (ICU) admission from January 1, 2015, to January 1, 2024, in a tertiary University hospital. Patient demographics, major comorbidities, ICU admission parameters, interventions and ICU complications were collected. An unfavorable neurological outcome at 3 months (UO) was defined as a Glasgow Outcome Scale (GOS) score of 1-3. A high therapy intensity level (TIL) was defined as a TIL basic of 3-4. A multivariable logistic regression model and a Cox proportional Hazard Regression model were used to assess the association of age and TIL with neurological outcome and mortality. A sensitivity analysis on low TIL (0-2) and high TIL subgroups was also conducted.
We enrolled 604 TBI patients, of which 240 (40%) had UO. The highest prevalence of UO was found in patients aged ≥80 years (53/94, 56%), followed by patients aged 50-79 years (104/255, 41%). The age group 35-49 years had the lowest rate of UO (38/127, 30%). Older patients (age ≥ 80 years) received less frequently high TIL than others ( = 0.03). In the multivariable analysis, age ≥ 80 years [OR: 3.42 (95% CI 1.72-6.81)] was independently associated with UO, while age ≥ 80 years [HR 5.42 (95% CI 3.00-9.79)] and age 50-79 years [HR 2.03, (95% CI 1.19-3.48)] were independently associated with mortality. Although there was no interaction between age groups and TIL on outcome, an exploratory analysis showed that in the high TIL subgroup of patients, age had no independent impact on the outcome, whereas, in the low TIL group, age ≥ 80 years was independently associated with UO [OR: 3.65 (95% CI: 1.64-8.14)].
Older age, especially in the setting of low intensity treatment, may impact short-term neurological outcome of traumatic brain-injured patients.
约三分之一的创伤相关死亡是由创伤性脑损伤（TBI）所致，在年轻人和老年患者中尤为常见。不同年龄组的管理策略可能有所不同，这可能会影响短期神经学预后。本研究旨在调查TBI患者在治疗方法和3个月神经学预后方面的年龄相关差异。
我们对2015年1月1日至2024年1月1日期间在一家三级大学医院因TBI需要入住重症监护病房（ICU）的患者进行了一项回顾性研究。收集了患者的人口统计学资料、主要合并症、ICU入院参数、干预措施和ICU并发症。将3个月时不良神经学预后（UO）定义为格拉斯哥预后量表（GOS）评分为1 - 3分。将高治疗强度水平（TIL）定义为TIL基础值为3 - 4分。使用多变量逻辑回归模型和Cox比例风险回归模型评估年龄和TIL与神经学预后及死亡率的关联。还对低TIL（0 - 2）和高TIL亚组进行了敏感性分析。
我们纳入了604例TBI患者，其中240例（40%）有UO。UO患病率最高的是年龄≥80岁的患者（53/94，56%），其次是50 - 79岁的患者（104/255，41%）。35 - 49岁年龄组的UO发生率最低（38/127，30%）。老年患者（年龄≥80岁）接受高TIL的频率低于其他患者（P = 0.03）。在多变量分析中，年龄≥80岁[比值比（OR）：3.42（95%置信区间1.72 - 6.81）]与UO独立相关，而年龄≥80岁[风险比（HR）5.42（95%置信区间3.00 - 9.79）]和年龄50 - 79岁[HR 2.03，（95%置信区间1.19 - 3.48）]与死亡率独立相关。尽管年龄组和TIL对预后没有交互作用，但一项探索性分析显示，在高TIL亚组患者中，年龄对预后没有独立影响，而在低TIL组中，年龄≥80岁与UO独立相关[OR：3.65（95%置信区间：1.64 - 8.14）]。
年龄较大，尤其是在低强度治疗的情况下，可能会影响创伤性脑损伤患者的短期神经学预后。
