Elderly patients with severe head injury in coma from the outset--has anything changed?

Abstract

Advancing age is known to be a determinant of outcome in head injury. We have sought to discover whether there has been any change in the outcome of elderly patients with severe head injury in Newcastle, where these patients have continued to be treated with maximum intervention. A review of prospectively collected data from the Newcastle Head Injury Database for the period 1990 to 2000 was carried out. All patients aged 70 years and above who had sustained a severe head injury (Glasgow Coma Score of 8 or less from the outset) were included. The Glasgow Outcome Score (GOS) was determined at 6 months. Seventy-one patients were identified. Fifty-seven (80%) died and 2 (3%) were in a vegetative state, 11 (16%) had severe disability, 1 (1%) had moderate disability and no patients made a good recovery. The natural history of this condition remains unchanged and due consideration should be given to this when evaluating interventions for elderly patients with a severe head injury.

Neurological outcomes of neurosurgical operations for multiple trauma elderly patients in Hong Kong

“…This was, in contrast to some previous published studies, in which none of the comatose traumatic brain injury patients aged above 70 years achieved good recovery and only 1% achieved independency in activity of daily living. [1415] Kilaru et al . reported that all traumatic brain injury patients aged 65 years or above with admission GCS 3/15 died.…”

Traumatic Brain Injury in the Elderly: Is it as Bad as we Think?

“…Acute subdural hematoma was the commonest pathology for elderly TBI [30], which corresponds with a coroner’s report that subdural hematoma was the commonest lesion of the deceased elderly persons with head injuries [12]. …”

“…The outcome was similar in the same center over 10 year’s time. However, the sample size was small [30]. …”

Management and Hospital Outcome of the Severely Head Injured Elderly Patient

“…Trauma is a leading cause of death among the elderly 1 . Poor outcomes in elderly patients compared with the young have been previously reported, 2,3 and there have been calls to carefully consider active treatment in the elderly trauma patients with severe head injury 4,5 . Cagetti et al 6 reported a 100% mortality rate in elderly patients aged >80 years, with a Glasgow Coma Scale (GCS) of 11 or less, and other studies have reported that surgery on elderly patients with a GCS of 5 or less was incompatible with survival 7 .…”