Geriatric head injuries - Experience and expectations

Abstract

It is widely known that global citizenry is continuing to age. The elderly head trauma patients, comprising 4.83% in our series are important from neurosurgical aspects. We conducted a study of elderly head injury patients admitted to our unit in last 11 years. Out of 620 patients, 423 males and 197 female, constituting a ratio of 2.1∶1. Fall constitutes the principle mode of injury (56.29%) followed by RTA (44.1%). We analyzed all the cases for surgical intervention after careful assessment of neurological condition. Amongst all cases operated for acute trauma, good recovery was seen in 51.8% and mortality in 41.7%, whereas in chronic subdural haematoma 84.2% cases showed good recovery as against mortality in 10.5%. In our society, due to very close family ties and desperation of family members to try active intervention even in patients with expected bleak outcome, we operated a fairly large number of cases and concluded that outcome was better after operative intervention.

Keywords

aged population - elderly trauma - geriatric - head injury - outcome

• References

• 1 Rouk LE AA, Nadvi SS. Acute extradural haematoma in the elderly. Br J Neurosurg 21 2007; 16-20
• 2 Park K. Preventive medicine in obstetrics, paediatrics and geriatrics. Text book of Preventive and Social Medicine Jan. 2005; 434 18eds
• 3 Callaway DW, Wolfe R. Geriatic trauma. Emer Med Clin N Amer 25 2007; 857-860
• 4 Maurice-Williams RS. Editorial: Head Injuries in elderly. Br J Neurosurg 13 1999; 5-8
• 5 Jennett B, Bond M. Assessment of outcome after severe brain damage, a practical scale. Lancet 01 1975; 480-484
• 6 Jamjoom D, Nelson R, Stranjalis G, Wood S, Chissell H, Kane N, Cummins B. Outcome following surgical evacuation of traumatic intracranial haematomas as in the elderly. Br J Neurosurg 06 1992; 27-32
• 7 Oreskovich MR, Howard JD, Copass MK, Carrico CJ. Geriatric trauma, injury pattern and outcome. J Trauma 24 2007; 565-572
• 8 Amacher AL, Bybee DE. Toleration of head injury by the elderly. Neurosurgery 20 1987; 954-958
• 9 Thompson HJ, McCormick WC, Kejan SH. Traumatic brain injury in older adults: epidemiology, outcome and future implications. J Am Ger Soc 54 2006; 159-245
• 10 Zwimpfer TJ, Moulton RJ. Neurologic trauma concerns. Crit Care Clin 09 1993; 727-739
• 11 Kotwica Z, Jakubowski JK. Acute head injuries in elderly: An analysis of 136 consécutive patients. Acta Neurochir (Wien) 118 1992; 98-102
• 12 Miller JD, Jones PA, Dearsden NM, Tocher JL. Progress in management of head injury. Br J Surg 79 1992; 60-64
• 13 Jennett B. Head injuries in elderly. In: Caird FI. (ed.) Neurological disorders in the elderly. 1982. Wright and Sons; Bristol: 202-211
• 14 Levati A, Farina ML, Vecchi G. et al Prognosis of severe head injuries. J Neurosurg 57 1982; 779-783
• 15 Reuter F, Warncke J. Traumatic intracranial haemorrhage in elderly people. In: Frowein R, Brock M, Klinger M. (eds.) Advances in Neurosurgery. 17 1989. Springer - Verlag; Berlin: 43-48
• 16 Braakman R, Gelpka GJ, Habbema JDR. et al Systematic selection of prognostic feature in patients with severe head injury. J Neurosurg 06 1980; 362-379
• 17 Klun B, Fettich M. Factor influencing the outcome in acute subdural haematoma. A review of 330 patients. Acta Neurochir 71 1984; 171-178
• 18 Pentland B, Jones PA, Rycw Malter JD. Head injury in the elderly. Age aging 15 1986; 193-202
• 19 Lewis MC, Abouelenin K, Paniagua M. Geriatric trauma: special consideration in the anesthesia management of injured. Anesthesiol Clin 25 2007; 75-90