Clinical article: mortality associated with severe head injury in the elderly
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- Patel, H.C., Bouamra, O., Woodford, M. et al. Acta Neurochir (2010) 152: 1353. doi:10.1007/s00701-010-0666-x
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Age is an important factor in determining prognosis following severe head injury (SHI), although mortality in patients ≥65 years is poorly reported. The aim of this study was to document mortality in patients with SHI ≥65 years.
A retrospective analysis of prospectively collected data from the TARN (Trauma Audit and Research Network) database (1996–2004) was performed. Six hundred and sixty-nine patients aged ≥65 with a GCS <9 after a head injury were identified, and mortality at 3 months was recorded.
Mortality was 71% in 65- to 70-year-old patients (n = 137) (CI, 64–79), 75% for patients aged 70–75 years (n = 147) (CI, 68–82), 85% in patients aged 75–80 years (n = 160) (79–91), and 87% for patients >80 years (n = 225) (CI, 83–91). Mortality for all patients ≥65 years with a GCS 3–5 was >80%. A better outcome was observed in patients with a GCS = 6–8 [65–70 years, 47% (CI, 30–64); 70–75 years, 56% (CI, 43–69); 75–80 years, 73% (CI, 62–85); >80 years, 79% (CI, 70–87)].
SHI-related mortality continues to increase with age. Overall, these data support a conservative approach to the severely head-injured elderly patient; however, patients presenting with a GCS = 6–8 and below the age of 75 may represent a group where more aggressive therapy may be indicated.