Retrospective Outcome Analysis of Geriatric Traumatic Brain Injury Treated at a Tertiary Care Center in India

Abstract

Background

Trauma is a major cause of morbidity and mortality in elderly patients and its management is challenging. Outcome assessment in these patients is difficult because of preexisting chronic medical conditions as it may be impossible to isolate the effect of traumatic brain injury. This study aimed to examine the clinical outcomes and epidemiological and clinicoradiological characteristics of geriatric traumatic brain injury patients at a tertiary care center.

Methods

The clinical records of patients aged ≥60 years with head injuries treated at King George's Medical University between 2016 and 2020 were included in the study. Patients were followed up in the outpatient department or through telephone consultation. The follow-up period was updated using the Glasgow outcome score (GOS) of patients for current neurological status and relevant radiological investigations.

Results

The mean age of subjects was 66.16 ± 6.55 years. Road traffic accidents were the most frequent cause of brain injuries (448 [68.5%]). In total, 41% of the study patients had severe head injuries (Glasgow coma scale, GCS < 9) at admission. The in-hospital mortality was 25.2%. In total, 60.7% of discharged patients showed favorable outcomes (GOS: 4 or 5). GCS at admission, best motor response, and associated comorbidity (diabetes mellitus) significantly predicted the outcome at 6 months. The majority of the patients (82.6 %) were 60 to 70 years of age.

Conclusion

Road traffic accidents are the most frequent cause of brain injuries in geriatrics. Most of them were managed medically, and majority were discharged (74.8%). Out of those discharged, 39.3% had unfavorable outcomes.

Keywords

Glasgow outcome score - comorbidity - traumatic brain injury - hematoma - hospital stay

Publikationsverlauf

Artikel online veröffentlicht:
16. September 2024

• References

• 1 Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveill Summ 2017; 66 (09) 1-16
• 2 Skaansar O, Tverdal C, Rønning PA. et al. Traumatic brain injury—the effects of patient age on treatment intensity and mortality. BMC Neurol 2020; 20 (01) 376
• 3 Faul M, Xu L, Wald MM. et al. Traumatic brain injury in the United States: national estimates of prevalence and incidence, 2002–2006. Inj Prev 2010; 16 (Suppl. 01) A268
• 4 Gardner RC, Dams-O'Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma 2018; 35 (07) 889-906
• 5 Al-Taei O, Al-Mirza A, Ali M, Al-Kalbani H, Al-Saadi T. Prevalence and outcomes of geriatric traumatic brain injury in developing countries: a retrospective study. Indian J Neurotrauma 2023; 20 (02) 101-106
• 6 Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res 2002; 24 (01) 24-28
• 7 Hazare P, Shukla D, Bhat D. et al. Prediction of surgical outcome for acute traumatic brain injury in older adults. Neurol India 2022; 70 (03) 1112-1118
• 8 Munivenkatappa A, Kumar V, Bhandarkar P, Roy N, Kamble J, Agrawal A. Neurotrauma in old aged: a study from India. Indian J Neurosurg 2017; 6 (01) 004-9
• 9 Bhatoe HS. Head injury in the elderly. Indian J Neurotrauma 2006; 3 (01) 5-6
• 10 Cuthbert JP, Harrison-Felix C, Corrigan JD. et al. Epidemiology of adults receiving acute inpatient rehabilitation for a primary diagnosis of traumatic brain injury in the United States. J Head Trauma Rehabil 2015; 30 (02) 122-135
• 11 Harvey LA, Close JC. Traumatic brain injury in older adults: characteristics, causes and consequences. Injury 2012; 43 (11) 1821-1826
• 12 Coronado VG, Thomas KE, Sattin RW, Johnson RL. The CDC traumatic brain injury surveillance system: characteristics of persons aged 65 years and older hospitalized with a TBI. J Head Trauma Rehabil 2005; 20 (03) 215-228
• 13 Dams-O'Connor K, Cuthbert JP, Whyte J, Corrigan JD, Faul M, Harrison-Felix C. Traumatic brain injury among older adults at level I and II trauma centers. J Neurotrauma 2013; 30 (24) 2001-2013
• 14 Singh R, Prasad RS, Singh K, Sahu A, Pandey N. Clinical, surgical and outcome predictive factor analysis of operated acute subdural hematoma cases: a retrospective study of 114 operated cases at tertiary centre. Indian J Neurosurg 2022; 11 (02) 128-135
• 15 Obanife HO, Ismail NJ, Lasseini A, Shehu BB, Otorkpa EJ. Risk factors, pattern and outcome of motorcycle-associated head injury in Sokoto: an analysis of 184 Cases. Indian J Neurotrauma 2021; 18 (02) 105-110
• 16 Mak CH, Wong SK, Wong GK. et al. Traumatic brain injury in the elderly: is it as bad as we think?. Curr Transl Geriatr Exp Gerontol Rep 2012; 1 (03) 171-178
• 17 Borkar SA, Sinha S, Agrawal D. et al. Severe head injury in the elderly: risk factor assessment and outcome analysis in a series of 100 consecutive patients at a Level 1 trauma centre. Indian J Neurotrauma 2011; 8 (02) 77-82
• 18 Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc 2006; 54 (10) 1590-1595
• 19 Shimoda K, Maeda T, Tado M, Yoshino A, Katayama Y, Bullock MR. Outcome and surgical management for geriatric traumatic brain injury: analysis of 888 cases registered in the Japan Neurotrauma Data Bank. World Neurosurg 2014; 82 (06) 1300-1306
• 20 Sinha VD, Gupta V, Singh DK. et al. Geriatric head injuries—experience and expectations. Indian J Neurotrauma 2008; 5 (02) 69-73
• 21 Yokobori S, Yamaguchi M, Igarashi Y. et al. Outcome and refractory factor of intensive treatment for geriatric traumatic brain injury: analysis of 1165 cases registered in the Japan Neurotrauma Data Bank. World Neurosurg 2016; 86: 127-133.e1
• 22 Pillai SV, Kolluri VR, Praharaj SS. Outcome prediction model for severe diffuse brain injuries: development and evaluation. Neurol India 2003; 51 (03) 345-349
• 23 Narayan RK, Greenberg RP, Miller JD. et al. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg 1981; 54 (06) 751-762
• 24 Pathak SM, Jindal AK, Verma AK, Mahen A. An epidemiological study of road traffic accident cases admitted in a tertiary care hospital. Med J Armed Forces India 2014; 70 (01) 32-35
• 25 Gupta P, Singh J, Sharma A. et al. Epidemiological analysis and clinical characteristics of traumatic brain injuries in rural Jaipur: the first single centre experience. J Evid Based Med Healthc. 2015; 2 (52) 8686-8691
• 26 Fu WW, Fu TS, Jing R, McFaull SR, Cusimano MD. Predictors of falls and mortality among elderly adults with traumatic brain injury: a nationwide, population-based study. PLoS One 2017; 12 (04) e0175868
• 27 Kumar RG, Juengst SB, Wang Z. et al. Epidemiology of comorbid conditions among adults 50 years and older with traumatic brain injury. J Head Trauma Rehabil 2018; 33 (01) 15-24
• 28 Baum CM, Wolf TJ, Wong AWK. et al. Validation and clinical utility of the executive function performance test in persons with traumatic brain injury. Neuropsychol Rehabil 2017; 27 (05) 603-617