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Operative versus non-operative treatment of traumatic brain injuries in patients 80 years of age or older

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Abstract

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.

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Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Patrick Czorlich, Marius Marc-Daniel Mader, Pedram Emami & Manfred Westphal

  2. Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Straße 200, 51109, Cologne, Germany

    Rolf Lefering

  3. Clinic for Orthopedics, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany

    Michael Hoffmann

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  1. Patrick Czorlich
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  4. Manfred Westphal
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Correspondence to Patrick Czorlich.

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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.

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This analysis was reported to the local ethic committee (WF-059-18). Informed consent was waived for this kind of study.

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Czorlich, P., Mader, M.MD., Emami, P. et al. Operative versus non-operative treatment of traumatic brain injuries in patients 80 years of age or older. Neurosurg Rev 43, 1305–1314 (2020). https://doi.org/10.1007/s10143-019-01159-4

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  • DOI: https://doi.org/10.1007/s10143-019-01159-4

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