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

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.

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Acknowledgements

We would like to thank the following participating hospitals in this study: Addenbrooke's Hospital, Wexham Park Hospital Slough, Frenchay Hospital, Airedale General Hospital Yorkshire, Royal Albert Edward Infirmary Wigan, Glan Clwyd District General Hospital, Torbay Hospital Devon, Arrowe Park Hospital Merseyside, Trafford General Hospital Manchester, Royal Bolton Hospital, Grantham & District Hospital, University Hospital Lewisham, Great Western Hospital Swindon, Hope Hospital Salford, Barnsley District General Hospital, Huddersfield Royal Infirmary, Royal Devon & Exeter Hospital, University Hospital North Staffordshire, Guys Hospital, Basildon Hospital Essex, Poole Hospital, Hull Royal Infirmary, University Hospital of North Tees, Prince Philip Hospital, Bassetlaw Hospital, Ipswich Hospital, Royal Hallamshire Hospital Sheffield, Princess Alexandra Hospital, University Hospital of Wales Cardiff, James Cook University Hospital, Royal Hampshire County Hospital, University Hospital, Aintree, Queen Alexandra Hospital, Birmingham Heartlands Hospital, James Paget Hospital, Royal Lancaster Infirmary, Queen Elizabeth Hospital Gateshead, Walton Centre for Neurology Liverpool, Jersey General Hospital, Blackpool Victoria Hospital, Royal Liverpool University Hospital, Warrington Hospital, John Radcliffe Hospital Oxon, Royal London Hospital, Bradford Royal Infirmary, Kent & Canterbury Hospital, Kent & Sussex Hospital, Watford General Hospital, Kettering General Hospital, Royal Preston Hospital, West Cumberland Hospital, Kings College Hospital London, Burnley General Hospital, Kings Mill Hospital Nottinghamshire, West Wales General Hospital, Calderdale Royal Hospital, Leeds General Infirmary, Royal Sussex County Hospital, Leicester Royal Infirmary, Royal United Hospital Bath, Weymouth & District Hospital, Royal Victoria Hospital Belfast, Leighton Hospital Cheshire, Whiston Hospital, City Hospital Birmingham, Lincoln County Hospital, Colchester General Hospital, Scarborough Hospital, Conquest Hospital East Sussex, Manchester Royal Infirmary, Scunthorpe General Hospital, Withybush General Hospital Dyfed, Countess of Chester Hospital, University Hospital Birmingham, Worcester Royal Infirmary, Hereford County Hospital, Worthing Hospital, Morriston Hospital, Wrexham Maelor Hospital, Nevill Hall Hospital, South Tyneside District Hospital, Wycombe Hospital, Newcastle General Hospital, Southampton General Hospital, Wythenshawe Hospital, Norfolk & Norwich General Hospital, York District Hospital, North Manchester General Hospital, Ysbyty Gwynedd District General, North Tyneside General Hospital, Derbyshire Royal Infirmary, Northampton General Hospital, Derriford Hospital, Northern General Hospital Sheffield, St George's Hospital London, Dewsbury District Hospital, St Helier Hospital, Nottingham University Hospital, St James' University Hospital Leeds, Peterborough District Hospital, Pilgrim Hospital, Pinderfields General Hospital, Stepping Hill Hospital, Eastbourne District General Hospital, Pontefract General Infirmary, Stoke Mandeville Hospital, Epsom Hospital, Queen Elizabeth Hospital Kings Lynn, Sunderland Royal Hospital, Fairfield General Hospital, Queen Elizabeth, Queen Mother Hospital Kent, and Tameside General Hospital, Rochdale Infirmary.

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Correspondence to Fiona E. Lecky.

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Comments

This is yet another informative and extremely well written manuscript from the Trauma Audit and Research Network. The management of severe head injury in the elderly is particularly challenging and difficult decisions have to be made. Historically it has been perceived that elderly patients presenting with severe head injury have a very poor prognosis. This paper identifies a subgroup aged below 75 with GCS 6-8 where more aggressive therapy may be indicated. This population data provides useful guidance but management decisions still need to be made on a per patient basis taking into many demographic, clinical and social factors.

Peter Hutchinson

Cambridge, UK

Financial disclosure

Omar Bouamra and Maralyn Woodford are employed by the University of Manchester as a result of TARN funding.

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Patel, H.C., Bouamra, O., Woodford, M. et al. Clinical article: mortality associated with severe head injury in the elderly. Acta Neurochir 152, 1353–1357 (2010). https://doi.org/10.1007/s00701-010-0666-x

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  • DOI: https://doi.org/10.1007/s00701-010-0666-x

Keywords

  • Elderly
  • Mortality
  • Severe head injury