Treatment for Geriatric Traumatic Brain Injury: A Nationwide Cohort Study

Abstract

Background: Because of the aging of the Japanese population, traumatic brain injuries (TBI) have increased in elderly adults. However, the effectiveness and prognosis of intensive treatment for geriatric TBI have not yet been determined. Thus, we used nationwide data from the Japan Neurotrauma Data Bank (JNTDB) projects to analyze prognostic factors for intensive and aggressive treatments. Methods:We analyzed 1,879 geriatric TBI cases (age !65 years) registered in four JNTDB projects: Project 1998 (P1998) to Project 2015 (P2015). Clinical features, use of aggressive treatment, and 6-month outcomes on the Glasgow Outcome Scale (GOS) were compared among study projects. Logistic regression was used to identify prognostic factors in aggressively treated patients. Results:The percentage of geriatric TBI cases significantly increased with time-P1998: 30.1%; Project 2004 (P2004): 34.6%; Project 2009 (P2009): 43.9%; P2015: 53.6%, p<0.0001). Use of aggressive treatment also significantly increased, from 67.0% in P1998 to 69.3% in P2015 (p<0.0001). Less invasive methods, such as trepanation and normothermic targeted temperature management, were more often chosen for geriatric patients. These efforts resulted in a significant decrease in the 6-month mortality rate, from 76.2% in P1998 to 63.1% in P2015 (p=0.0003), although the percentage of severely disabled patients increased, from 8.9% in P1998 to 11.1% in P2015 (p=0.0003). Intraventricular hemorrhage was the factor most strongly associated with unfavorable 6-month outcomes (OR 3.79, 95% CI 1.78-8.06, p<0.0001). Conclusions:Less invasive treatments reduced mortality in geriatric TBI but did not improve functional outcomes. Patient age was not the strongest prognostic factor; thus, physicians should consider characteristics other than age.

Hyperfibrinolysis and fibrinolysis shutdown in patients with traumatic brain injury

“…Fifth, coagulation and fibrinolytic function has not been evaluated by VEDs such as TEG and ROTEM. Finally, in Japan, the population is aging and the mean age of TBI patients is high 49 . As a result, it may appear that there is an overrepresentation of older patients with severe TBI.…”

Trends in mortality rates and correlations between intracranial injuries and external causes: A Japanese population study

“…The age distribution of patients with TBI is rapidly changing in Japan. Previous reports from the Japan Neurotrauma Data Bank (JNTDB) have shown a decrease in the proportion of TBI in younger persons and an increase in older persons as a proportion of the total population [ 14 , 15 ]. Older people are more likely to experience TBI because of falls or traffic collisions, which can damage the brain and blood vessels in the skull [ 16 ].…”

Recent Advances in Cell-Based Therapies for Ischemic Stroke

“…The discovery of NSCs provided a promising new therapy for the treatment of a variety of neurological diseases and injuries, such as Parkinson's disease, Huntington's disease, Alzheimer's disease, multiple sclerosis, amyotrophic lateral sclerosis, spinal cord injury, traumatic brain injury, and stroke, all of which are characterized by the failure of endogenous repair mechanisms in the CNS to restore damaged tissue and rescue lost functions [92,93]. As shown in Table 2, many studies have assessed NSC transplantation to treat ischemic brain injury in animal models.…”

“…Although transplanted NSCs are expected to differentiate into various neural cells rather than other stem cells, it remains unclear to what extent this contributes to functional recovery. The current understanding is that transplanted NSCs likely prevent neuronal apoptosis, exert immunomodulatory effects inside and outside the brain, increase endogenous neuronal regeneration and angiogenesis, and inhibit glial scar formation mainly via paracrine and autocrine secretion of various neurotrophic factors rather than differentiation [ 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 109 , 110 ] ( Table 2 ).…”