Geriatric Traumatic Brain Injury: An Attempt to Predict Outcome Using a Nomogram.

BACKGROUND AND OBJECTIVES

With improving life expectancy, the proportion of geriatric patients is steadily increasing in the population and traumatic brain injury (TBI) in the elderly is becoming a problem demanding increasing attention from the health community. We attempted to identify factors that correlate with the outcome (as measured by the Glasgow Outcome Scale [GOS]) in elderly patients with TBI and make a prognostic model.

MATERIALS AND METHODS

A prospective analysis of 220 consecutive TBI patients aged ≥60 years admitted at our hospital was performed. Data about demography, comorbidities, mode of injury, clinico-radiological features, associated injuries, medical/surgical complications, and outcome was analyzed. Patients without imaging findings of TBI and patients with chronic subdural hematoma (SDH) and lesional intracranial hemorrhage were excluded.

RESULTS

The mean age of patients was 69.17 years, with 70.9% being males. Motor vehicle accidents (44%) and ground-level falls (43.7%) were the most common modes of injury. Antiplatelets and anticoagulants were being taken by 14.6% and 1.8% of patients, respectively. Out of 220 patients, 124 patients had mild, 48 had moderate, and 48 had severe head injuries. Median Rotterdam score (RS) was 2. Forty-one patients underwent surgery. The outcome was favorable (GOS 4-5) in 54.1% and unfavorable (GOS 1-3) in 45.9% of patients, with the overall mortality at the end of 1 month being 30.9%. On multivariate regression analysis, Glasgow Coma Scale (GCS), RS, and coagulation abnormality were found to be independent prognostic factors; these three variables were then used to design a nomogram.

CONCLUSION

In the absence of specific geriatric TBI prognostic models, a nomogram using GCS, RS, and coagulation abnormality can be used as a prognostic model.