Operative versus non-operative treatment of traumatic brain injuries in patients 80 years of age or older
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Traumatic brain injury (TBI) in older adults is an increasing issue in modern medicine. Nevertheless, it remains unclear which patients presenting with TBI and 80 years of age or older benefit from an operative treatment. The aim of this study was to explore the effect of an operative treatment in isolated TBI patients ≥ 80 years of age. Data were derived from the TraumaRegister DGU® from 2002 to 2016. Inclusion criteria were ≥ 80 years of age, an Abbreviated Injury ScaleHead (AIS) ≥ 3, and an AISNon-Head ≤ 1. The cohort was split in operatively and non-operatively treated patients, and outcome was assessed at discharge using the Glasgow Outcome Scale (GOS). A favorable outcome was defined as a GOS of 4 or 5. A total of 1.693 patients (431 operatively and 1.262 non-operatively treated patients) were analyzed. Mortality rate was 54.4% (687 patients) in the non-operative group and 49.4% in the operative group. Simultaneously, there were more patients discharged with a GOS 2 (persistent vegetative state) in the operative group (7.9%, 34 patients) than in the non-operative group (1.0%, 13 patients). An analysis of the operatively treated patients showed an association between a higher mortality risk and brainstem hemorrhage (p = 0.04), fixed pupils (p = 0.001), initial intubation (p = 0.03), and an AISHead of 5/6 (p = 0.03). Patients 80 years of age or older seem to benefit from an operative treatment regarding mortality rate. However, there has been a higher rate of a poor neurological outcome particularly with regard to persistent vegetative state in the operative treatment group at discharge.
KeywordsTraumatic brain injury Elderly Geriatric Mortality Age Outcome Surgery
Compliance with ethical standards
Conflict of interest
Rolf Lefering was paid for statistical reviews from European Journal of Trauma. He is employed by the University of Witten/Herdecke which has a service agreement with the AUC/German Society for Trauma Surgery for scientific assistance, annual audit reports, etc. Rolf Lefering received sponsoring from the DFG (Deutsche Forschungsgemeinschaft), BAST (Federal Highway Research Institute of the Federal Republic of Germany), BMBF (Federal Ministry of Education and Research of the Federal Republic of Germany), and several other research foundations. He also received payments for lectures at the KKS Düsseldorf and Frankfurt; and at Mibeg for education in statistics for study nurses, study physicians, and project managers.
All other authors have no conflicts of interest.
Ethical approval/informed consent
This analysis was reported to the local ethic committee (WF-059-18). Informed consent was waived for this kind of study.
- 5.Emami P, Czorlich P, Fritzsche FS, Westphal M, Rueger JM, Lefering R, Hoffmann M (2017) Impact of Glasgow Coma Scale score and pupil parameters on mortality and outcome in pediatric and adult severe traumatic brain injury: a retrospective, multicenter cohort study. J Neurosurg 126:760–767CrossRefGoogle Scholar
- 7.Haasper C, Junge M, Ernstberger A, Brehme H, Hannawald L, Langer C, Nehmzow J, Otte D, Sander U, Krettek C, Zwipp H (2010) The Abbreviated Injury Scale (AIS). Options and problems in application. Unfallchirurg 113:366–372 [in German]Google Scholar
- 10.Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ, RESCUEicp Trial Collaborators (2016) Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med 375:1119–1130CrossRefGoogle Scholar
- 27.Stein DM, Kozar RA, Livingston DH, Luchette F, Adams SD, Agrawal V, Arbabi S, Ballou J, Barraco RD, Bernard AC, Biffl WL, Bosarge PL, Brasel KJ, Cooper Z, Efron PA, Fakhry SM, Hartline CA, Hwang F, Joseph BA, Kurek SJ, Moore FA, Mosenthal AC, Pathak AS, Truitt MS, Yelon JA, AAST Geriatric Trauma/ACS Committee (2018) Geriatric traumatic brain injury-what we know and what we don’t. J Trauma Acute Care Surg 85:788–798CrossRefGoogle Scholar