Rajendran Gunaseelan, Mahalingam Sasikumar, Ramkumar Anitha, Tamilarasu Kumaresh Pillur, Kannan Rahini
Department of Emergency Medicine and Trauma, Aarupadai Veedu Medical College and Hospital, Vinayaka Missions' Research Foundation (DU), Puducherry, India.
Turk J Emerg Med. 2025 Apr 1;25(2):92-99. doi: 10.4103/tjem.tjem_133_24. eCollection 2025 Apr-Jun.
The management of traumatic brain injury in elderly patients remains a topic of conflicting evidence in the literature. While some studies suggest that surgical intervention is beneficial, others indicate increased mortality and morbidity. Therefore, we conducted this retrospective matched cohort study to further investigate the role of surgical and conservative management for traumatic brain injury in elderly individuals.
The authors conducted a retrospective review comparing patients with traumatic brain injury who underwent nonoperative management (NOM) versus those who underwent operative management (OM). Case matching was employed to create an artificial control group matched for age, sex, noncontrast computed tomography (NCCT) findings, and symptoms at a 1:1 ratio of treatment to control. The inclusion criteria included patients aged 60 years and above who presented to the emergency medicine department with head injuries resulting from various causes, such as road traffic accidents, falls, or assault, whereas the exclusion criteria included polytrauma, severe hypovolemic shock, and referrals to other institutions. The outcomes of interest included all-cause mortality and Glasgow Outcome Scale (GOS) scores, with statistical significance set at < 0.05.
Optimal case matching was achieved for 52 out of 96 patients who underwent surgical management. There was no statistically significant difference in all-cause mortality between patients who underwent surgical management (32.69%) and those who did not (28.82%). Similarly, there was no statistically significant difference in the GOS score at 1 month between the two groups. A subgroup analysis based on the severity of traumatic brain injury and radiological diagnosis of intracranial injury revealed no difference between the OM and NOM groups, except for patients who underwent midline shift surgery.
There was no difference in all-cause mortality among elderly patients with traumatic brain injury regardless of whether they received conservative or surgical management, except for patients who underwent midline shift surgery.
老年患者创伤性脑损伤的管理在文献中仍是一个存在相互矛盾证据的话题。虽然一些研究表明手术干预有益，但其他研究则指出死亡率和发病率会增加。因此，我们开展了这项回顾性匹配队列研究，以进一步探究手术和保守治疗在老年创伤性脑损伤患者中的作用。
作者进行了一项回顾性分析，比较接受非手术治疗（NOM）和手术治疗（OM）的创伤性脑损伤患者。采用病例匹配方法，以1:1的治疗与对照比例创建一个在年龄、性别、非增强计算机断层扫描（NCCT）结果和症状方面相匹配的人工对照组。纳入标准包括60岁及以上因道路交通事故、跌倒或袭击等各种原因导致头部受伤并就诊于急诊科的患者，而排除标准包括多发伤、严重低血容量性休克以及转诊至其他机构的患者。感兴趣的结局包括全因死亡率和格拉斯哥预后量表（GOS）评分，统计学显著性设定为<0.05。
96例接受手术治疗的患者中有52例实现了最佳病例匹配。接受手术治疗的患者（32.69%）和未接受手术治疗的患者（28.82%）之间的全因死亡率无统计学显著差异。同样，两组在1个月时的GOS评分也无统计学显著差异。基于创伤性脑损伤严重程度和颅内损伤放射学诊断的亚组分析显示，除了接受中线移位手术的患者外，OM组和NOM组之间没有差异。
除接受中线移位手术的患者外，老年创伤性脑损伤患者无论接受保守治疗还是手术治疗，全因死亡率均无差异。
