Severe head injury in elderly: 6-year comparison of treatment and outcome between southern Finland and Navarra (Spain)

  • Bismil Ali AliEmail author
  • Tuomas Brinck
  • Lauri Handolin
  • Tomas Belzunegui Otano
Original Article



To compare the profile, treatment and outcome of elderly patients with severe traumatic brain injuries (TBI) between southern Finland and Navarra (Spain).


Data collected from, 2010 to 2015, in the Major Trauma Registry of Navarra (MTR-N) and the Helsinki Trauma Registry (HTR) were compared. Patients with New Injury Severity Score (NISS) ≥ 16 and age ≥ 65 with isolated severe TBI were considered. Patients who had been admitted to the hospital ≥ 24 h after the trauma, had been pronounced dead before hospital arrival, or had been injured by hanging, drowning or burns, were excluded. Outcome was defined by 30-day hospital mortality. The expected mortality was calculated using the Revised Injury Severity Classification score II (RISC II). Other compared data included demographics, injury mechanism, pre-hospital and hospital treatment, and time intervals.


A total of 305 (MTR-N) and 137 (HTR) patients were included in the outcome analysis. The standardized mortality ratio with 95% confidence interval was for MTR-N 1.4 (1.1–1.6) and for HTR 0.8 (0.6–1.1). Patients in Navarra were older (average 79.7 vs. 75.0) while in southern Finland the percentage of pre-hospital intubation in patients with GCS ≤ 8 (75.0% vs 50.0%) and ICU admission (72.2% vs 22.0%) were higher.


The better adjusted outcome of elderly patients with severe TBI in southern Finland in comparison to Navarra could be due to higher rate of pre-hospital intubation and/or higher rate of ICU admissions in southern Finland. Increasing number of elderly patients with severe TBI necessitate uniformly accepted protocols in pre- and in-hospital management.


Elderly trauma patients Severe traumatic brain injury Major trauma Trauma registry Benchmarking 


Compliance with ethical standards

Conflict of interest

Bismil Ali, Tuomas Brinck, Lauri Handolin and Tomas Belzunegui declare that they have no conflict of interest.

Permission note (ethics)

The study has been approved by the Ethics Committee of the Department of Health of the government of Navarra. The subjects gave their informed consent to the work. The investigation carried out was approved and evaluated by the National Agency for Quality and Accreditation of Spain, ANECA. This study has also been approved by the review board of the Helsinki University Hospital.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Bismil Ali Ali
    • 1
    Email author
  • Tuomas Brinck
    • 2
  • Lauri Handolin
    • 2
  • Tomas Belzunegui Otano
    • 1
    • 3
  1. 1.Accident and Emergency DepartmentComplejo Hospitalario de Navarra, Health service of Navarra-OsasunbideaPamplonaSpain
  2. 2.Trauma Unit, Helsinki University HospitalUniversity of HelsinkiHelsinkiFinland
  3. 3.Department of HealthPublic University of NavarraPamplonaSpain

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