DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20184199

Outcome in elderly individuals with moderate and severe head injury: a tertiary centre experience

Gurusamy Rajasekaran, Raju Venkatesh

Abstract


Background: The prognosis of patients with moderate and severe head injuries is poor in elderly individuals which affects not only their families and also the society. An accurate and early prediction of survival and functional outcome becomes essential and important to decide the aggressiveness of treatment after the informed counseling of relatives. The aim of the present study was to assess the impact of the age on the outcome of the elderly individual with moderate and severe head injury and to compare it with the outcome of younger age group.

Methods: Authors retrospectively evaluated 250 patients with moderate (GCS 9-13) and severe (GCS 3-8) TBI after categorizing them into group A (above 60 years of age) and group B (20-59 years of age). Age, sex, mode of injury, level of consciousness as in GCS, management and CT findings were assessed for outcome and comparisons were made.

Results: The mean age for good outcome in elderly group is 66.8 and for bad outcome is 70.1 years. The mean age for good outcome in younger group is 33.2 and for bad outcome is 47.5 years. Elderly patients fare worse in all factors assessed when compared to younger group.

Conclusions: Head injuries in old age associated with poor GCS serves as a basis for making early prediction for the likelihood of poor outcome. 


Keywords


Elderly age, GCS, Outcome, TBI

Full Text:

PDF

References


Bruce DA, Schut L, Bruno LA, Wood JH, Sutton LN. Outcome following severe head injuries in children. J Neurosurg. 1978 May;48(5):679-88.

Marshall LF, Gautille T, Klauber MR, Eisenberg HM, Jane JA, Luerssen TG, et al. The outcome of severe closed head injury. Special Supplements. 1991 Nov;75(1S):S28-36.

Wilberger Jr JE, Harris M, Diamond DL. Acute subdural hematoma: morbidity, mortality, and operative timing. J Neurosurg. 1991 Feb;74(2):212-8.

Braakman R, Gelpke GJ, Habbema JD, Maas AI, Minderhoud JM. Systematic selection of prognostic features in patients with severe head injury. Neurosurg. 1980 Apr 1;6(4):362-70.

Bullock HR, Povlishock JT. Guidelines for the management of severe head injury. J Trauma. 1996;13:639-731.

Tandon PN. Management of head injury: Fads, fashions and facts. Neurol India. 1986;34:1-30.

The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint section on Neuro trauma and Critical care. J. Neurotrauma. 2000;17:573-81.

Marshall LF, Marshall SB, Klauber MR, Clark MV, Eisenberg HM, Jane JA, et al. A new classification of head injury based on computerized tomography. Special Supplements. 1991 Nov;75(1S):S14-20.

Pentland B, Jones OA, Roy CW, Miller JD. Head injury in the elderly. Age Ageing 1986 July; 15(4): 193-202.

Jennett B, Teasdale G, Braakman R, Minderhoud J, Knill-Jones R. Predicting outcome in individual patients after severe head injury. Lancet. 1976 May 15;307(7968):1031-4.

Carlsson CA, von Essen C, Löfgren J. Factors affecting the clinical course of patients with severe head injuries: part 1: influence of biological factors part 2: significance of posttraumatic coma. J Neurosurg. 1968 Sep;29(3):242-51.

Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974 Jul 13;304(7872):81-4.

Jennett B, Teasdale G, Galbraith S, Pickard J, Grant H, Braakman R, et al. Severe head injuries in three countries. J Neurol Neurosurg Psychiatry. 1977 Mar 1;40(3):291-8.

Jennett B, Teasdale G. Aspects of coma after severe head injury. Lancet. 1977 Apr 23;309(8017):878-81.

Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R. The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg. 1977 Oct;47(4):491-502.

Ruff RM, Marshall LF, Crouch J, Klauber MR, Levin HS, Barth J, et al. Predictors of outcome following severe head trauma: follow-up data from the Traumatic Coma Data Bank. Brain Injury. 1993 Jan 1;7(2):101-11.

Miller JD, Becker DP, Ward JD, Sullivan HG, Adams WE, Rosner MJ. Significance of intracranial hypertension in severe head injury. J Neurosurg. 1977 Oct;47(4):503-16.

Becker DP. Acute subdural hematoma. Neu Trauma. Springer Verlag. 1986:51-95.

Hernesniemi J. Outcome following head injuries in the aged. Acta Neurochirurg. 1979 Mar 1;49(1-2):67-79.

Jennett B, Teasdale G, Braakman R, Minderhoud J, Heiden J, Kurze T. Prognosis of patients with severe head injury. Neurosurgery. 1979 Apr 1;4(4):283-9.

Kilaru S, Garb J, Emhoff T, Fiallo V, Simon B, Swiencicki T, et al. Long-term functional status and mortality of elderly patients with severe closed head injuries. J Trauma Acute Care Surg. 1996 Dec 1;41(6):957-63.

Kotwica Z, Jakubowski JK. Acute head injuries in the elderly. An analysis of 136 consecutive patients. Acta Neurochir (Wien). 1992;118(3-4):98-102.

Vollmer DG, Torner JC, Jane JA, Sadovnic B, Charlebois D, Eisenberg HM, et al. Age and outcome following traumatic coma: why do older patients fare worse?. Special Supplements. 1991 Nov;75(1S):S37-49.

Baltas I, Gerogiannis N, Sakellariou P, Matamis D. Prassas A, Fylaktakis M. Outcome in severely head injured patients with and without multiple trauma. J Neu Surg Sci. 1998;42(2):85-8.

Strich SJ. Diffuse degeneration of the cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiatry. 1956 Aug;19(3):163.

Ng I, Lew TW, Yeo TT, Seow WT, Tan KK, Ong PL, et al. Outcome of patients with traumatic brain injury managed on a standardised head injury protocol. Ann Academy Med Singapore. 1998 May;27(3):332-9.

Pickard JD, Bailey S, Sanderson H, Rees M, Garfield JS. Steps towards cost-benefit analysis of regional neurosurgical care. BMJ. 1990 Sep 29;301(6753):629-35.