Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome.
01 May 2002-Journal of Trauma-injury Infection and Critical Care (J Trauma)-Vol. 52, Iss: 5, pp 907-911
TL;DR: The mortality from TBI is higher in the geriatric population at all levels of head injury, in addition, functional outcome at hospital discharge is worse and age itself is an independent predictor for mortality in TBI.
Abstract: Background Geriatric trauma patients have a worse outcome than the young with comparable injuries. The contribution of traumatic brain injury (TBI) to this increased mortality is unknown and has been confounded by the presence of other injuries. The purpose of this study was to investigate the role
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TL;DR: The case burden of TBI across World Health Organization regions and World Bank income groups was sought to promote advocacy, understanding, and targeted intervention, and study quality was higher in the high-income countries (HICs) than in the low- and middle- Income countries (LMICs).
Abstract: OBJECTIVETraumatic brain injury (TBI)—the “silent epidemic”—contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the authors sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups.METHODSOpen-source epidemiological data on road traffic injuries (RTIs) were used to model the incidence of TBI using literature-derived ratios. First, a systematic review on the proportion of RTIs resulting in TBI was conducted, and a meta-analysis of study-derived proportions was performed. Next, a separate systematic review identified primary source studies describing mechanisms of injury contributing to TBI, and an additional meta-analysis yielded a proportion of TBI that is secondary to the mechanism of RTI. Then, the incidence of RTI as published by the Global...
1,353 citations
TL;DR: A refocusing of research efforts on this population is justified to prevent TBI in the older adult and to discern unique care requirements to facilitate best patient outcomes.
Abstract: Traumatic brain injury (TBI) is a significant problem in older adults. In persons aged 65 and older, TBI is responsible for more than 80,000 emergency department visits each year; three-quarters of these visits result in hospitalization as a result of the injury. Adults aged 75 and older have the highest rates of TBI-related hospitalization and death. Falls are the leading cause of TBI for older adults (51%), and motor vehicle traffic crashes are second (9%). Older age is known to negatively influence outcome after TBI. Although geriatric and neurotrauma investigators have identified the prognostic significance of preadmission functional ability, comorbidities, sex, and other factors such as cerebral perfusion pressure on recovery after illness or injury, these variables remain understudied in older adults with TBI. In the absence of good clinical data, predicting outcomes and providing care in the older adult population with TBI remains problematic. To address this significant public health issue, a refocusing of research efforts on this population is justified to prevent TBI in the older adult and to discern unique care requirements to facilitate best patient outcomes.
511 citations
Cites background from "Isolated traumatic brain injury: ag..."
...Once admitted to inpatient rehabilitation facilities, older patients with TBI require longer stays, resulting in greater costs.(3,61) Additional understanding of outcomes in older patients with TBI has been gleaned from the trauma literature....
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TL;DR: Activity level after concussion affected symptoms and neurocognitive recovery, and athletes engaging in high levels of activity after concussion demonstrated worse neuroc cognitive performance.
Abstract: Context: Evidence suggests that athletes engaging in high-intensity activities after concussion have more difficulties with cognitive recovery. Objective: To examine the role postinjury ac...
432 citations
TL;DR: It is concluded that outcome following TBI is dependent on age, race, to a lesser extent on education, but not on gender, and the prognostic effect of race and education were sustained.
Abstract: Outcome following traumatic brain injury (TBI) is not only dependent on the nature and severity of injury and subsequent treatment, but also on constituent characteristics of injured individuals. We aimed to describe and quantify the relationship between demographic characteristics and six month outcome assessed by the Glasgow Outcome Scale (GOS) after TBI. Individual patient data on age (n = 8719), gender (n = 8720), race (n = 5320), and education (n = 2201) were extracted from eight therapeutic Phase III randomized clinical trials and three surveys in moderate or severe TBI, contained in the IMPACT database. The strength of prognostic effects was analyzed with binary and proportional odds regression analysis and expressed as an odds ratio. Age was analyzed as a continuous variable with spline functions, and the odds ratio calculated over the difference between the 75 th and 25 th percentiles. Associations with other predictors were explored. Increasing age was strongly related to poorer outcome (OR 2.14; 95% CI 2.00-2.28) in a continuous fashion that could be approximated by a linear function. No gender differences in outcome were found (OR: 1.01; CI 0.92-1.11), and exploratory analysis failed to show any gender/age interaction. The studies included predominantly Caucasians (83%); outcome in black patients was poorer relative to this group (OR 1.30; CI 1.09-1.56). This relationship was sustained on adjusted analyses, and requires further study into mediating factors. Higher levels of education were weakly related to a better outcome (OR: 0.70; CI 0.52-0.94). On multivariable analysis adjusting for age, motor score, and pupils, the prognostic effect of race and education were sustained. We conclude that outcome following TBI is dependent on age, race, to a lesser extent on education, but not on gender.
276 citations
TL;DR: Functional outcome after isolated mild TBI as measured by the Glasgow Outcome Scale and modified FIM is generally good to excellent for both elderly and younger patients.
Abstract: Objective:Elderly patients (aged 60 years and older) have been demonstrated to have an increased mortality after isolated traumatic brain injury (TBI); however, the prognosis of those patients surviving their hospitalization is unknown. We hypothesized that surviving elderly patients would also have
263 citations
References
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TL;DR: The increased morbidity and mortality related to severe trauma to an extracranial organ system appeared primarily attributable to associated hypotension, and improvements in trauma care delivery over the past decade have not markedly altered the adverse influence of hypotension.
Abstract: As triage and resuscitation protocols evolve, it is critical to determine the major extracranial variables influencing outcome in the setting of severe head injury. We prospectively studied the outcome from severe head injury (GCS score < or = 8) in 717 cases in the Traumatic Coma Data Bank. We investigated the impact on outcome of hypotension (SBP < 90 mm Hg) and hypoxia (Pao2 < or = 60 mm Hg or apnea or cyanosis in the field) as secondary brain insults, occurring from injury through resuscitation. Hypoxia and hypotension were independently associated with significant increases in morbidity and mortality from severe head injury. Hypotension was profoundly detrimental, occurring in 34.6% of these patients and associated with a 150% increase in mortality. The increased morbidity and mortality related to severe trauma to an extracranial organ system appeared primarily attributable to associated hypotension. Improvements in trauma care delivery over the past decade have not markedly altered the adverse influence of hypotension. Hypoxia and hypotension are common and detrimental secondary brain insults. Hypotension, particularly, is a major determinant of outcome from severe head injury. Resuscitation protocols for brain injured patients should assiduously avoid hypovolemic shock on an absolute basis.
1,977 citations
TL;DR: The incidence of disability in young people and adults admitted with a head injury is higher than expected and reflects the high rate of sequelae previously unrecognised in the large number of patients admitted to hospital with an apparently mild head injury.
Abstract: Objective: To determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community. Design: Prospective, hospital based cohort study, with one year follow up of sample stratified by coma score. Setting: Five acute hospitals in Glasgow. Subjects: 2962 patients (aged 14 years or more) with head injury; 549 (71%) of the 769 patients selected for follow up participated. Main outcome measures: Glasgow outcome scale and problem orientated questionnaire. Results: Survival with moderate or severe disability was common after mild head injury (47%, 95% confidence interval 42% to 52%) and similar to that after moderate (45%, 35% to 56%) or severe injury (48%, 36% to 60%). By extrapolation from the population identified (90% of whom had mild injuries), it was estimated that annually in Glasgow (population 909 498) 1400 young people and adults are still disabled one year after head injury. Conclusion: The incidence of disability in young people and adults admitted with a head injury is higher than expected. This reflects the high rate of sequelae previously unrecognised in the large number of patients admitted to hospital with an apparently mild head injury.
626 citations
TL;DR: A mathematical model embodying the known mechanical properties of subdural veins was used to develop tolerance criteria for the occurrence of ASDH, which was consistent with the clinical and experimental data but differed from tolerances previously proposed for head injury.
Abstract: Acute subdural hematoma (ASDH) due to ruptured bridging veins occurs under acceleration conditions associated with high rates of acceleration onset. That this is due to the strain-rate sensitivity of these veins was confirmed in an experimental model of ASDH. The results of this model were consisten
433 citations
TL;DR: In 1986, invasive monitoring was began in all patients with any of these risk factors and modified this in 1987 to emergent monitoring, postponing all but the most critical diagnostic studies and reducing time to monitoring to 2.2 hours by limiting diagnostic tests.
Abstract: In 1985, we treated 60 patients more than 65 years of age who sustained blunt multiple trauma, excluding burns and minor falls. A pedestrian-motor vehicle mechanism, initial BP<150 mm Hg, acidosis, multiple fractures, and head injuries all predicted mortality. To investigate this, in 1986, we began invasive monitoring in all patients with any of these risk factors and modified this in 1987 to emergent monitoring, postponing all but the most critical diagnostic studies. All patients included were hemodynamically stable after initial evaluation. Attempts were made to optimize all patients with volume, inotropes, and afterload reduction as needed. There was no difference between 1986 and 1987 in patient age, injury severity, or per cent of patients requiring operation
301 citations
TL;DR: Older patients had higher rates of mortality overall; vegetative survival was seen in 4.8% to 8.0% of patients and did not exhibit a trend related to age; injury severity, as assessed by motor score or Glasgow Coma Scale score, did not significantly differ according to age.
Abstract: ✓ To better understand the relationship between patient age and clinical outcome following traumatic coma, the data for 661 patients, aged 15 years or older at the time of receiving a nonpenetrating head injury, were analyzed All patients were prospectively followed and the information was entered into the Traumatic Coma Data Bank This information was statistically analyzed to determine trends and interactions between patient age and other prognostic indicators Older patients had higher rates of mortality overall; vegetative survival was seen in 48% to 80% of patients and did not exhibit a trend related to age Injury severity, as assessed by motor score or Glasgow Coma Scale score, did not significantly differ according to age The injury mechanism was age-related, with a greater frequency of falls and pedestrian accidents in older patients Multiple injury was less frequent in older patients Medical complications and systemic trauma were considered to be the primary cause of death in less than 25%
289 citations