ObjectiveAge is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital.MethodsWe collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3-8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator.ResultsTypes of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares.ConclusionEthical training and developing decision-making skills are necessary including shared decision making.

Group I had higher uDPD/uCr values (p < 0.05) compared to group II and group III (40.49 ± 11.1 vs 30.7 ± 16.3 and 24.78 ± 10.54). No differences were observed in other bone markers among all groups. The dietary calcium intake was adequate (> of EAR, Estimated Average Requirement) in only 19% of children, but no differences in both LS and TB BMD were revealed. Nevertheless, children with inadequate calcium intake had significant increased (p < 0.05) ALP/ bALP, compared to the rest of patients. Summary/Conclusion: In our study, 10% of children with Haemophilia A had low for chronological age LS BMD. Severe disease and history of FVIII inhibitor seem to burden bone health, as measured with DXA. Resorption markers were found to be impaired. Homeostasis of calcium seem to overweigh low dietary intake. Severe cases, especially those with history of inhibitor, are in higher risk to develop bone metabolic disturbances; thus, close monitoring of bone status seems to be necessitated.