Geriatric head injuries: impact and outcomes

Authors

  • Vallabh B. Nagocha Department of Neurosurgery, Dr. SN Medical College and associated MDM hospital, Jodhpur, Rajasthan, India
  • Manish Yadav Department of Neurosurgery, Dr. SN Medical College and associated MDM hospital, Jodhpur, Rajasthan, India
  • Divyam Sharma Department of Neurosurgery, Dr. SN Medical College and associated MDM hospital, Jodhpur, Rajasthan, India
  • Sunil Garg Department of Neurosurgery, Dr. SN Medical College and associated MDM hospital, Jodhpur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20193929

Keywords:

Aged population, Chronic subdural hematoma, Elderly trauma, Geriatric, Traumatic brain injury

Abstract

Background: Elderly trauma patients present unique challenges and face  more  significant obstacles in  recovery  than  their younger  counterparts. They usually experience higher morbidity and mortality and slower recovery trajectories and have, on average, worse functional, cognitive, and psychosocial outcomes months or years post-injury than do younger patients.

Methods: Authors conducted a study of elderly head injury patients to understand the epidemiology of geriatric TBI, the impact of comorbidities and management issues and  outcomes in such patients. Authors had a total of 110 patients who presented with traumatic brain injury and were admitted in this hospital over 2 years. Authors also reviewed the literatures to study the factors affecting outcome after geriatric TBI and studied the role of aggressive neurosurgical management in geriatric TBI.

Results: Among 68%(n=75) of the patients were male and 32% females. Age group of 60-65 years was the highest with 60.9% patients. Patients with GCS of 8 and below had the highest mortality rates of 68 %. Overall  mortality  rate  was  32.72%  and  9.09 %  of  the patients survived in a vegetative condition. The proportion of injury secondary to fall was the largest single group in 50.9% patients, and Chronic SDH was the most common pathology seen in 36.45 % patients. Highest mortality was seen in patients with Diffuse Axonal Injury (69.23 %). Out of the 110 patients , 57 patients underwent surgery for various pathologies. Chronic SDH were the most common operated pathology followed by acute SDH. Glassgow outcome scale was used as the measure of outcome in these series of patients.  32.72 % patients had a GOS score of 1 and 9.09 % had a score of 2. 18.18 % patients remained severely disabled with a score of 3 and nine patients (8.18 %) had a score of 4 and thirty five patients had good recovery (GOS-5).

Conclusions: Due to the better treatment options there is an increase in the number of elderly around the world. Thus, the number of eldery individuals presenting with TBI to the emergency department is also on the rise more commonly due to falls than road traffic accidents. There is a need for specific prognostic and management guidelines for the elderly which can lead to better diagnosis, care and recovery and eventual short- and long-term outcomes in the elderly.

References

Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: a global perspective. Neuro Rehabilitation. 2007;22(5):341-53.

Park K. Preventive medicine in obstetrics, paediatrics and geriatrics. Text book of Preventive and Social Medicine, 18 Ed. India, Bhanot; 2005:434.

Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths-United States, 2007 and 2013. Morbidity and mortality weekly report. MMWR Surveill Summ. 2017;66(9):1-16.

Cuthbert JP, Harrison-Felix C, Corrigan JD, Kreider S, Bell JM, Coronado VG, et al. Epidemiology of adults receiving acute inpatient rehabilitation for a primary diagnosis of traumatic brain injury in the United States. J Head Trauma Rehabil. 2015;30(6):122-35.

LeBlanc J, De Guise E, Gosselin N, Feyz M. Comparison of functional outcome following acute care in young, middleaged and elderly patients with traumatic brain injury. Brain Inj. 2006;20(8):779-90.

Harvey LA, Close JCT. Traumatic brain injury in older adults: characteristics, causes and consequences. Injury. 2012;43(11):1821-6.

Coronado VG, Thomas KE, Sattin R, Johnson RL. The CDC traumatic brain injury surveillance system: characteristics of persons aged 65 years and older hospitalized with a TBI. J Head Trauma Rehabil. 2005;20(3):215-28.

Dams-O’Connor K, Cuthbert JP, Whyte J, Corrigan JD, Faul M, Harrison-Felix C. Traumatic brain injury among older adults at level I and II trauma centers. J Neurotrauma. 2013;30(24):2001-13.

Liu H, Yang Y, Xia Y, Zhu W, Leak RK, Wei Z et al. Aging of cerebral white matter. Ageing Res. Rev. 2013;34:64-76.

Ikonomovic MD, Mi Z, Abrahamson EE. Disordered APP metabolism and neurovasculature in trauma and aging: combined risks for chronic neurodegenerative disorders. Ageing Res Rev. 2017;34:51-63.

YinY, Sun G, Li E, Kiselyov K, Sun, D. ER stress and impaired autophagy flux in neuronal degeneration and brain injury. Ageing Res. Rev. 2017;4:3-14.

Ramanathan DM, McWilliams N, Schatz P, Hillary FG. Epidemiological shifts in elderly traumatic brain injury: 18- year trends in Pennsylvania. J. Neurotrauma 2012;29:1371-8.

McIntyre A, Mehta S, Aubut J, Dijkers M, Teasell RW. Mortality among older adults after a traumatic brain injury: a meta-analysis. Brain Inj. 2013;27:31-40.

Dams-O'Connor K, Gibbons LE, Bowen JD, McCurry SM, Larson EB, Crane PK. Risk for late-life re-injury,dementia and death among individuals with traumatic brain injury: a population-based study. J Neurol Neurosurg Psychiatry. 2013;84(2):177-82.

Wan X, Liu S, Wang S, Zhang S, Yang H, Ou Y, et al. Elderly patients with severe traumatic brain injury could benefit from surgical treatment. World Neurosurg. 2016 May 1;89:147-52.

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

Petridis AK, Dorner L, Doukas A, Eifrig S, Barth H, Mehdorn M. Acute subdural hematoma in the elderly; clinical and CT factors influencing the surgical treatment decision. Cent Eur Neurosurg. 2009;70(2):73-8.

Lilley EJ, Williams KJ, Schneider EB, Hammouda K, Salim A, Haider AH, et al. Intensity of treatment, endof-life care, and mortality for older patients with severe traumatic brain injury. J Trauma Acute Care Surg. 2016;80(6):998-1004.

De Bonis P, Pompucci A, Mangiola A, D'Alessandris QG, Rigante L, Anile C. Decompressive craniectomy for the treatment of traumatic brain injury: does an age limit exist? J Neurosurg. 2010;112(5):1150-3.

Taussky P, Hidalgo ET, Landolt H, Fandino J. Age and salvageability: analysis of outcome of patients older than 65 years undergoing craniotomy for acute traumatic subdural hematoma. World Neurosurg. 2012;78:306-11.

Jennett B, Bond M. Assessment of outcome after severe brain damage, a practical scale. Lancet. 1975;1(7905):480-4.

Harvey LA, Close JCT. Traumatic brain injury in older adults: characteristics, causes and consequences. Injury. 2012;43(11):1821-6.

Center for Disease Control and Prevention (CDC). Nonfatal fall-related traumatic brain injury among older adults-California,1996-1999. MMWR Morb Mortal Wkly Rep. 2003;52(13):276-8.

Alberico AM, Ward JD, Choi SC, Marmarou A, Young HF. Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J. Neurosurg. 1987;67:648-56.

Sinha VD, Gupta V, Singh DK, Chopra S, Gupta P, Bagaria H. Geriatric head injuries-Experience and expectations. Indian J Neurotrauma. 2008 ;5(02):69-73.

Bloch F. Is the Glasgow Coma Scale appropriate for the evaluation of elderly patients in long-term care units? J Eval Clin Pract. 2016;22:455-6.

Zwimpfer TJ, Moulton RJ. Neurologic trauma concerns. Crit Care Clin. 1993;9:727-39.

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?. Journal of Neurosurg. 1991;75:S37-49.

Mitra B, Cameron PA, Gabbe BJ, Rosenfeld JV, Kavar B. Management and hospital outcome of the severely head injured elderly patient. ANZ J Surg. 2008;78:588-92.

Brazinova A, Mauritz W, Leitgeb J, Wilbacher I, Majdan M, Janciak I, et al. Outcomes of patients with severe traumatic brain injury who have Glasgow Coma Scale scores of 3 or 4 and are over 65 years old. J Neurotrauma. 2010;27(9):1549-55.

Stocchetti N, Paterno R, Citerio G, Beretta L, Colombo A. Traumatic brain injury in an aging population. J Neurotrauma. 2012;29(6):1119-25.

You W, Feng J, Tang Q, Cao J, Wang L, Lei J, et al. Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study. BMC Anesthesiol. 2016;16(1):35.

Dang Q, Simon J, Catino J, Puente I, Habib F, Zucker L et al. More fateful than fruitful? Intracranial pressure GERIATRIC TBI 903 monitoring in elderly patients with traumatic brain injury is associated with worse outcomes. J Surg Res. 2015;19(2):482-8.

Bauer J, Harrison G, Grandhi R, Voronovich, Z, Puccio A, Okonkwo DO. Pre-morbid and hospital course factors affecting intracranial hemorrhage expansion and mortality in the elderly post traumatic brain injury. J Neurotrauma. 2012;29:A44-5.

Grandhi R, Harrison G, Voronovich Z, Bauer J, Chen SH, Nicholas D, et al. Preinjury warfarin, but not antiplatelet medications, increases mortality in elderly traumatic brain injury patients. J Trauma Acute Care Surg. 2015;78(3):614-21.

Annegers JF, Coan SP. The risks of epilepsy after traumatic brain injury. Seizure 2000;9(7):453-7.

Annegers JF, Hauser WA, Coan SP, Rocca WA. A population-based study of seizures after traumatic brain injuries. N Engl J Med. 1998;338:20-4.

Leppik IE, Bergey GK, Ramsay RE, Rowan AJ, Gidal BE, Birnbaum AK, et al. Advances in antiepileptic drug treatments. A rational basis for selecting drugs for older patients with epilepsy. Geriatrics. 2004;59(12):14-18,22-14.

Mosenthal AC, Livingston DH, Lavery RF, Knudson MM, Lee S, Morabito D, at al. The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial. J Trauma. 2004;56(5):1042-8.

Vossel KA, Ranasinghe KG, Beagle AJ, Mizuiri D, Honma SM, Dowling AF. Incidence and impact of subclinical epileptiform activity in Alzheimer’s disease. Ann Neurol. 2016;80(6):858-70.

Raj R, Mikkonen ED, Kivisaari R, Skrifvars MB, Korja M, Siironen J. Mortality in elderly patients operated for an acute subdural hematoma: a surgical case series. World Neurosurg. 2016;88:592-7.

Kristman VL, Brison RJ, Bedard M, Reguly P, Chisholm S. Prognostic markers for poor recovery after mild traumatic brain injury in older adults: a pilot cohort study. J Head Trauma Rehabil. 2016;31:E33-43.

Asikainen I, Kaste M, Sarna S. Early and late posttraumatic seizures in traumatic brain injury rehabilitation patients: brain injury factors causing late seizures and influence of seizures on long-term outcome. Epilepsia. 1999;40:584-9.

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Published

2019-08-27

How to Cite

Nagocha, V. B., Yadav, M., Sharma, D., & Garg, S. (2019). Geriatric head injuries: impact and outcomes. International Journal of Research in Medical Sciences, 7(9), 3461–3467. https://doi.org/10.18203/2320-6012.ijrms20193929

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Original Research Articles