Acta Neurochirurgica

, Volume 152, Issue 8, pp 1353–1357 | Cite as

Clinical article: mortality associated with severe head injury in the elderly

  • H. C. Patel
  • Omar Bouamra
  • Maralyn Woodford
  • David W. Yates
  • Fiona E. Lecky
Clinical Article

Abstract

Background

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.

Methods

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.

Findings

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)].

Conclusions

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.

Keywords

Elderly Mortality Severe head injury 

References

  1. 1.
    American Association of Neurological Surgeons (2000) Part II: Early indicators of prognosis in severe traumatic brain injury. Management and prognosis of severe traumatic brain injury, pp 171–286Google Scholar
  2. 2.
    Adekoya N, Thurman DJ, White DD, Webb KW (2002) Surveillance for traumatic brain injury deaths—United States, 1989–1998. MMWR Surveill Summ 51:1–14PubMedGoogle Scholar
  3. 3.
    Baker SP, O’Neill B (1976) The injury severity score: an update. J Trauma 16:882–885PubMedCrossRefGoogle Scholar
  4. 4.
    Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME (1989) A revision of the Trauma Score. J Trauma 29:623–629PubMedCrossRefGoogle Scholar
  5. 5.
    Committee on Injury Scaling and Association for the Advancement of Automotive Medicine (1990) The abbreviated injury scale 1990 revision. Des Plaines, IllinoisGoogle Scholar
  6. 6.
    Gan BK, Lim JH, Ng IH (2004) Outcome of moderate and severe traumatic brain injury amongst the elderly in Singapore. Ann Acad Med Singapore 33:63–67PubMedGoogle Scholar
  7. 7.
    Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF, Murray GD, Maas AI (2003) Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg 99:666–673PubMedCrossRefGoogle Scholar
  8. 8.
    Jamjoom A, Nelson R, Stranjalis G, Wood S, Chissell H, Kane N, Cummins B (1992) Outcome following surgical evacuation of traumatic intracranial haematomas in the elderly. Br J Neurosurg 6:27–32PubMedCrossRefGoogle Scholar
  9. 9.
    Johnson CL, Margulies DR, Kearney TJ, Hiatt JR, Shabot MM (1994) Trauma in the elderly: an analysis of outcomes based on age. Am Surg 60:899–902PubMedGoogle Scholar
  10. 10.
    Kilaru S, Garb J, Emhoff T, Fiallo V, Simon B, Swiencicki T, Lee KF (1996) Long-term functional status and mortality of elderly patients with severe closed head injuries. J Trauma 41:957–963PubMedCrossRefGoogle Scholar
  11. 11.
    Maurice-Williams RS (1999) Head injuries in the elderly. Br J Neurosurg 13:5–8PubMedCrossRefGoogle Scholar
  12. 12.
    Munro PT, Smith RD, Parke TRJ (2002) Effect of patients age on management of acute intracranial haematoma: a prospective national study. BMJ 325:1001PubMedCrossRefGoogle Scholar
  13. 13.
    Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ (2002) Specialist neurocritical care and outcome from head injury. Intensive Care Med 28:547–553PubMedCrossRefGoogle Scholar
  14. 14.
    Pennings JL, Bachulis BL, Simons CT, Slazinski T (1993) Survival after severe brain injury in the aged. Arch Surg 128:787–793PubMedGoogle Scholar
  15. 15.
    Susman M, DiRusso SM, Sullivan T, Risucci D, Nealon P, Cuff S, Haider A, Benzil D (2002) Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma 53:219–223PubMedCrossRefGoogle Scholar
  16. 16.
    Ushewokunze S, Nannapaneni R, Gregson BA, Stobbart L, Chambers IR, Mendelow AD (2004) Elderly patients with severe head injury in coma from the outset–has anything changed? Br J Neurosurg 18:604–607PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • H. C. Patel
    • 1
  • Omar Bouamra
    • 2
  • Maralyn Woodford
    • 2
  • David W. Yates
    • 2
  • Fiona E. Lecky
    • 2
  1. 1.Department of NeurosurgeryHope HospitalSalfordUK
  2. 2.The Trauma Audit and Research NetworkUniversity of Manchester, Manchester Medical Academic Health Science Centre, Hope HospitalSalfordUK

Personalised recommendations