Abstract
Purpose
We studied the impact of age on survival and functional recovery in brain-injured patients.
Methods
We performed an observational cohort study of all consecutive adult patients with brain injury admitted to ICU in 8 years. To estimate the optimal cut-off point of the age associated with unfavorable outcomes (mRS 3–6), receiver operating characteristic (ROC) curve analyses were used. Multivariate logistic regression analyses were performed to identify prognostic factors for unfavorable outcomes.
Results
We included 619 brain-injured patients. We identified 60 years as the cut-off point at which the probability of unfavorable outcomes increases. Patients ≥ 60 years had higher severity scores at ICU admission, longer duration of mechanical ventilation, longer ICU and hospital stays, and higher mortality. Factors identified as associated with unfavorable outcomes (mRS 3–6) were an advanced age (≥ 60 years) [Odds ratio (OR) 4.59, 95% confidence interval (CI) 2.73–7.74, p < 0.001], a low GCS score (≤ 8 points) [OR 3.72, 95% CI 1.95–7.08, p < 0.001], the development of intracranial hypertension [OR 5.52, 95% CI 2.70–11.28, p < 0.001], and intracerebral hemorrhage as the cause of neurologic disease [OR 3.87, 95% CI 2.34–6.42, p < 0.001].
Conclusion
Mortality and unfavorable functional outcomes in critically ill brain-injured patients were associated with older age (≥ 60 years), higher clinical severity (determined by a lower GCS score at admission and the development of intracranial hypertension), and an intracerebral hemorrhage as the cause of neurologic disease.
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References
Peñuelas O, Muriel A, Abraira V, Frutos-Vivar F, Mancebo J, Raymondos K et al (2020) Inter-country variability over time in the mortality of mechanically ventilated patients. Intensive Care Med 46:444–453
Pelosi P, Ferguson ND, Frutos-Vivar F, Anzueto A, Putensen C, Raymondos K et al (2011) Management and outcome of mechanically ventilated neurologic patients. Crit Care Med 39:1482–1492
Susman M, DiRusso SM, Sullivan T, Risucci D, Nealon P, Cuff S et al (2002) Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma 53:219–224
Mosenthal AC, Lavery RF, Addis M, Kaul S, Ross S, Marburger R et al (2002) Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma 52:907–911
Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF et al (2003) Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg 99:666–673
LeBlanc J, de Guise E, Gosselin N, Feyz M (2006) Comparison of functional outcome following acute care in young, middle-aged and elderly patients with traumatic brain injury. Brain Inj 20:779–790
Lenell S, Nyholm L, Lewén A, Enblad P (2019) Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care. Acta Neurochir (Wien) 161:1243–1254
McIntyre A, Mehta S, Aubut J, Dijkers M, Teasell RW (2013) Mortality among older adults after a traumatic brain injury: a meta-analysis. Brain Inj 27:31–40
Mosenthal AC, Livingston DH, Lavery RF, Knudson MM, Lee S, Morabito D et al (2004) The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial. J Trauma 56:1042–1048
Reeder KP, Rosenthal M, Lichtenberg P, Wood D (1996) Impact of age on functional outcome following traumatic brain injury. J Head Trauma Rehabil 11:22–31
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative STROBE (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335:806–808
Esteban A, Anzueto A, Frutos-Vivar F, Alía I, Ely EW, Brochard L et al (2004) Outcome of older patients receiving mechanical ventilation. Intensive Care Med 30:639–646
Vollmer D, Torner J, Jane J (1991) Age and outcome following traumatic coma: why do older patients fare worse? J Neurosurg 75(suppl):S37–S49
Ferrell RB, Kaloyan ST (2002) Traumatic brain injury in older adults. Curr Psychiatry Rep 4:354–362
Marquez de la Plata CD, Hart T, Hammond FM, Frol AB, Hudak A, Harper CR et al (2008) Impact of age on long-term recovery from traumatic brain injury. Arch Phys Med Rehabil 89:896–903
Canadian Institute for Health Information (2006) Head injuries in Canada: a decade of change. CIHI, Ottawa, ON
Thompson HJ, McCormick WC, Kagan SH (2006) Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc 54:1590–1595
Thompson HJ, Rivara FP, Jurkovich GJ, Wang J, Nathens AB, MacKenzie EJ (2008) Evaluation of the effect of intensity of care on mortality after traumatic brain injury. Crit Care Med 36:282–290
Rengel KF, Hayhurst CJ, Pandharipande PP, Hughes CG (2019) Long-term cognitive and functional impairments after critical illness. Anesth Analg 128:772–780
Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE et al (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355
Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L et al (2008) Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 177:170–177
Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Peñuelas O, Abraira V et al (2013) Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 188:220–230
Tejerina EE, Pelosi P, Robba C, Peñuelas O, Muriel A, Barrios D, Frutos-Vivar F et al (2021) Evolution over time of ventilator management and outcome of patients with neurologic disease. Crit Care Med 49:1095–1106
Asehnoune K, Mrozek S, Perrigault PF, Seguin P, Dahyot-Fizelier C, Lasocki S et al (2017) A multi-faceted strategy to reduce ventilation-associated mortality in brain-injured patients. The BI-VILI project: a nationwide quality improvement project. Intensive Care Med 43:957–970
Roquilly A, Cinotti R, Jaber S, Vourc’h M, Pengam F, Mahe PJ et al (2013) Implementation of an evidence-based extubation readiness bundle in 499 brain-injured patients. A before-after evaluation of a quality improvement project. Am J Respir Crit Care Med 188:958–966
Cnossen MC, Polinder S, Andriessen TM, van der Naalt J, Haitsma I, Horn J et al (2017) Causes and consequences of treatment variation in moderate and severe traumatic brain injury: a multicenter study. Crit Care Med 45:660–669
Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ (2002) Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 30:1870–1876
Barnato AE, Albert SM, Angus DC, Lave JR, Degenholtz HB (2011) Disability among elderly survivors of mechanical ventilation. Am J Respir Crit Care Med 183:1037–1042
Broessner G, Helbok R, Lackner P, Mitterberger M, Beer R, Engelhardt K et al (2007) Survival and long-term functional outcome in 1,155 consecutive neurocritical care patients. Crit Care Med 35:2025–2030
Kiphuth IC, Schellinger PD, Köhrmann M, Bardutzky J, Lücking H, Kloska S et al (2010) Predictors for good functional outcome after neurocritical care. Crit Care 14:R136
Corbanese U, Possamai C, Dal Cero P (2004) Outcome of patients who underwent mechanical ventilation following intracerebral hemorrhage: is the glass really half full? Crit Care Med 32:1431
Roch A, Michelet P, Jullien AC, Thirion X, Bregeon F, Papazian L et al (2003) Long-term outcome in intensive care unit survivors after mechanical ventilation for intracerebral hemorrhage. Crit Care Med 31:2651–2656
Shen L, Wang Z, Su Z, Qiu S, Xu J, Zhou Y et al (2016) Effects of intracranial pressure monitoring on mortality in patients with severe traumatic brain injury: a meta-analysis. PLoS ONE 11(12):e0168901
Dijkers M, Gordon WA, Abreu B, Graham J, Charness A (2008) The intersection of aging/age and TBI: systematic review methodology. Brain Injury Prof 5:8–11
Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
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This study was funded by Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES).
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Tejerina, E.E., Gonçalves, G., Gómez-Mediavilla, K. et al. The effect of age on clinical outcomes in critically ill brain-injured patients. Acta Neurol Belg 123, 1709–1715 (2023). https://doi.org/10.1007/s13760-022-01987-0
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DOI: https://doi.org/10.1007/s13760-022-01987-0