Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury

Ostermann, Roman C.; Joestl, Julian; Tiefenboeck, Thomas M.; Lang, Nikolaus; Platzer, Patrick; Hofbauer, Marcus

doi:10.1186/s13018-018-0975-y

Cited by 40 publications

(34 citation statements)

References 25 publications

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“…The possible reasons could be that older patients likely had more co-morbidities, less neurological and physical reserves and a higher tendency of poly-pharmacy which could affect recovery. 31–33 This could account for there being no detectable cognitive FIM gain observed in our elderly group. Other reasons for the dismal cognitive FIM gain are discussed in a later section.…”

Section: Discussionmentioning

confidence: 76%

Demographics of traumatic brain injury and outcomes of continuous chain of early rehabilitation in Singapore

Lui

Fook‐Chong

Teo

2020

Proceedings of Singapore Healthcare

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Background: Evidence shows that early initiation of a continuous chain of rehabilitation is associated with better functional outcomes in traumatic brain injured patients. The Department of Rehabilitation Medicine initiated early screening and review of patients with all traumatic brain injury (TBI) severity within 72 hours of acute admission, followed by direct transfer of suitable patients to acute inpatient rehabilitation (AIR). Objectives: This study aim to document the demographics and clinical characteristics of all TBI patients admitted to the local acute hospital; determine the characteristics of patients with TBI who are directly transferred to AIR following early screening and review; and determine clinical predictors affecting functional outcomes of patients of all TBI severity. Methods: A total of 491 patients were screened and reviewed; 116 patients were directly transferred to AIR. Results: The median age of the screened cohort was 67.0 years (interquartile range 50.0–77.0 years). Falls were the leading mechanism of TBI. Infection (odds ratio (OR)=2.95, 95% confidence interval (CI) 1.59–5.49) and neurosurgical intervention (OR=2.18, 95% CI 1.24–3.81) increased the odds of transfer to AIR. The Functional Independence Measure (FIM) gain after receiving AIR was significant ( p<0.001). Increased age, complications, high motor admission FIM (AFIM) and long rehabilitation length of stay (RLOS) were negatively associated with FIM gain and FIM efficiency. Conclusions: Our study demonstrated that falls were the leading mechanism of TBI, with the majority of patients being older. Infection and neurosurgical intervention increased the likelihood of transfer to AIR. There was functional improvement after AIR. Age, complications, motor AFIM and RLOS were negatively associated with FIM gain and FIM efficiency. Further local research is warranted to confirm these findings.

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Section: Discussionmentioning

confidence: 76%

Demographics of traumatic brain injury and outcomes of continuous chain of early rehabilitation in Singapore

Lui

Fook‐Chong

Teo

2020

Proceedings of Singapore Healthcare

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“…In the adult population accessing an Emergency Department (ED) for a traumatic brain injury, more cases of SDHs than EDHs are shown in elderly patients [ 70 , 71 , 72 , 73 ]. Unlike the general adult population, the percentage of elderly men is comparable to that of women [ 24 , 26 , 32 , 33 , 40 , 43 , 46 ] in the case of both SDHs and EDHs.…”

Section: Epidemiologymentioning

confidence: 99%

Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating

et al. 2021

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Epidural hematomas (EDHs) and subdural hematomas (SDHs), or so-called extra-axial bleedings, are common clinical entities after a traumatic brain injury (TBI). A forensic pathologist often analyzes cases of traumatic EDHs or SDHs due to road accidents, suicides, homicides, assaults, domestic or on-the-job accidents, and even in a medical responsibility scenario. The aim of this review is to give an overview of the published data in the medical literature, useful to forensic pathologists. We mainly focused on the data from the last 15 years, and considered the most updated protocols and diagnostic-therapeutic tools. This study reviews the epidemiology, outcome, and dating of extra-axial hematomas in the adult population; studies on the controversial interdural hematoma are also included.

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“…6 These issues lead to costly length of stay (LOS) and prolonged postdischarge care, which makes early identification of frail TBI patients important for health care savings. 3,5,7…”

Section: Introductionmentioning

confidence: 99%

The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury

Tracy

Carlin

Tyson

et al. 2020

The American Surgeon™

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Background Frailty has been studied extensively in trauma, but there is minimal research detailing its impact on traumatic brain injury (TBI). We hypothesized that the 11-item modified frailty index (mFI-11) would predict complications and discharge outcomes in patients with TBI. Methods A retrospective review of our trauma quality improvement program (TQIP) registry was conducted for all patients with TBI. The mFI-11 score was calculated for each patient. Multivariable logistic regression was used to assess the relationship between mFI-11 and cardiovascular, infectious, pulmonary, renal, thromboembolic, and unplanned complications (ie, unplanned intensive care unit [ICU] admission, intubation, or return to the operating room). Results There were 2352 patients with TBI of whom 61.6% (n = 1450) were not frail, 19.3% (n = 454) were mildly frail, and 19.1% (n = 448) were moderately to severely frail. Higher frailty scores were associated with increasing age ( P < .0001) and decreasing injury severity score [ISS] ( P = 0.001). Higher frailty scores also correlated with increasing rates of a skilled nursing facility/long-term acute care hospital/rehabilitation discharge ( P = .0002). On multivariable logistic regression adjusting for age, Glasgow Coma Scale (GCS) score, ISS, mechanism, and sex, moderate to severe frailty increased the odds of acute kidney injury (odds ratio [OR] 2.06, 95% CI 1.07-3.99, P = .03) and any unplanned event (OR 1.6, 95% CI 1.1-2.3, P = .01). Conclusion Frailty measured by the mFI-11 is associated with greater rates of discharge to unfavorable locations and increased odds of acute kidney injury and unplanned events among patients with TBI. These findings suggest that frail patients with TBIs require greater vigilance to avoid such unanticipated outcomes.

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Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury

Cited by 40 publications

References 25 publications

Demographics of traumatic brain injury and outcomes of continuous chain of early rehabilitation in Singapore

Demographics of traumatic brain injury and outcomes of continuous chain of early rehabilitation in Singapore

Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating

The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury

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