Promising clinical outcome of elderly with TBI after modern neurointensive care

Merzo, Abraham; Lenell, Samuel; Nyholm, Lena; Enblad, Per; Lewén, Anders

doi:10.1007/s00701-015-2639-6

Cited by 30 publications

(14 citation statements)

References 40 publications

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“…The main cause of trauma in all elderly age groups was fall (Table 1 ), which is in accordance with our earlier findings [ 22 , 28 ] as well as with the results of many other studies [ 8 , 15 , 17 , 19 , 23 , 34 , 36 , 40 ]. Although there was a predominant injury mechanism, there was a notable significant difference between the age groups regarding several other characteristics (Table 1 ).…”

Section: Discussionsupporting

confidence: 92%

“…An updated periodic evaluation of NIC of TBI patients made by us showed substantial increase of the proportion of patients > 60 years treated from 16 to 30% between 1996–1997 and 2008–2009 [ 22 ]. Furthermore, when clinical outcome was evaluated in the elderly TBI patients who received NIC, 51% of patients age ≥ 65 had favorable outcome [ 28 ]. Those relatively favorable results indicate that elderly patients with TBI should not be excluded from NIC.…”

Section: Introductionmentioning

confidence: 99%

“…Outcome after traumatic brain injury (TBI) has improved over time with the development of neurointensive care (NIC) [3, 4, 9, 10, 26, 27, 30, 48] despite the fact that favorable outcome decreases with increasing age [16, 21, 28, 29, 38, 44], and there is an increasing proportion of elderly in the TBI population [17, 19, 33, 34]. The United Nations reports that the population aged 60 or older is growing faster than all the younger age groups and expects the number of persons over 60 years to be more than doubled by 2050 [46].…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care

et al. 2019

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Background The probability of favorable outcome after traumatic brain injury (TBI) decreases with age. Elderly, ≥ 60 years, are an increasing part of our population. Recent studies have shown an increase of favorable outcome in elderly over time. However, the optimal patient selection and neurointensive care (NIC) treatments may differ in the elderly and the young. The aims of this study were to examine outcome in a larger group of elderly TBI patients receiving NIC and to identify demographic and treatment related prognostic factors. Methods Patients with TBI ≥ 60 years receiving NIC at our department between 2008 and 2014 were included. Demographics, co-morbidity, admission characteristics, and type of treatments were collected. Clinical outcome at around 6 months was assessed. Potential prognostic factors were included in univariate and multivariate regression analysis with favorable outcome as dependent variable. Results Two hundred twenty patients with mean age 70 years (median 69; range 60–87) were studied. Overall, favorable outcome was 46% (Extended Glasgow Outcome Scale (GOSE) 5–8), unfavorable outcome 27% (GOSE 2–4), and mortality 27% (GOSE 1). Significant independent negative prognostic variables were high age ( p < 0.05), multiple injuries ( p < 0.05), GCS M ≤ 3 on admission ( p < 0.05), and mechanical ventilation ( p < 0.001). Conclusions Overall, the elderly TBI patients > 60 years receiving modern NIC in this study had a fair chance of favorable outcome without large risks for severe deficits and vegetative state, also in patients over 75 years of age. High age, multiple injuries, GCS M ≤ 3 on admission, and mechanical ventilation proved to be independent negative prognostic factors. The results underline that a selected group of elderly with TBI should have access to NIC.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care

et al. 2019

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“…151,152 Regardless of the presence or absence of an inflection point, it is clear that a substantial number of older adults with TBI may recover well ( Table 1, Table 2, and Supplementary Table; see online supplementary material at http://www.liebertpub .com/neu), including some with severe TBI who receive aggressive neurosurgical management. 29,92,138,[153][154] The role of provider attitudes as well as patient and family preferences must also be considered when interpreting outcomes in older adults with TBI, who may be more likely to have care electively withdrawn. 155 The issue of provider attitudes was highlighted in a large UK study of patients with TBI and cerebral contusions, reporting that increasing age was associated with longer delays in obtaining an initial head CT, lower likelihood of being transferred to a neurotrauma center, and lower likelihood of review by a senior (vs. junior) physician.…”

Section: The Controversial Role Of Agementioning

confidence: 99%

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

Gardner

Dams-O’Connor

Morrissey

et al. 2018

Journal of Neurotrauma

331

286

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This review of the literature on traumatic brain injury (TBI) in older adults focuses on incident TBI sustained in older adulthood ("geriatric TBI") rather than on the separate, but related, topic of older adults with a history of earlier-life TBI. We describe the epidemiology of geriatric TBI, the impact of comorbidities and pre-injury function on TBI risk and outcomes, diagnostic testing, management issues, outcomes, and critical directions for future research. The highest incidence of TBI-related emergency department visits, hospitalizations, and deaths occur in older adults. Higher morbidity and mortality rates among older versus younger individuals with TBI may contribute to an assumption of futility about aggressive management of geriatric TBI. However, many older adults with TBI respond well to aggressive management and rehabilitation, suggesting that chronological age and TBI severity alone are inadequate prognostic markers. Yet there are few geriatric-specific TBI guidelines to assist with complex management decisions, and TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include under-representation of older adults in TBI research, lack of systematic measurement of pre-injury health that may be a better predictor of outcome and response to treatment than age and TBI severity alone, and lack of geriatric-specific TBI common data elements (CDEs). This review highlights the urgent need to develop more age-inclusive TBI research protocols, geriatric TBI CDEs, geriatric TBI prognostic models, and evidence-based geriatric TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing geriatric TBI population.

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“…For instance, elderly TBIs are at greater risk of worse functional recovery than younger TBI patients (McIntyre et al, 2013). However, in literature, studies are showing that elderly TBI patients respond well to neurosurgical treatment and rehabilitation, suggesting that chronological age alone is not an adequate indicator of prognosis (McIntyre et al, 2013;Merzo et al, 2016). For this reason, it has been suggested that additional prognostic factors, such as MCs, should be considered when evaluating the clinical evolution of elderly TBI patients (Estraneo et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Medical Complications in Predicting the Rehabilitation Outcome of Patients With Disorders of Consciousness After Severe Traumatic Brain Injury

Lucca

Lofaro

Leto

et al. 2020

Front. Hum. Neurosci.

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Promising clinical outcome of elderly with TBI after modern neurointensive care

Cited by 30 publications

References 40 publications

Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care

Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

The Impact of Medical Complications in Predicting the Rehabilitation Outcome of Patients With Disorders of Consciousness After Severe Traumatic Brain Injury

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