PDF herunterladen
CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 809-820
DOI: 10.4103/ajns.AJNS_205_20
Review Article

Management of mild brain trauma in the elderly: Literature review

Federica Marrone
1   Department of Neurosurgery, San Salvatore Hospital, L'Aquila
2   Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila
,
Luca Zavatto
1   Department of Neurosurgery, San Salvatore Hospital, L'Aquila
2   Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila
,
Mario Allevi
1   Department of Neurosurgery, San Salvatore Hospital, L'Aquila
2   Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila
,
Hambra Di Vitantonio
1   Department of Neurosurgery, San Salvatore Hospital, L'Aquila
,
Daniele Millimaggi
1   Department of Neurosurgery, San Salvatore Hospital, L'Aquila
,
Soheila Dehcordi
1   Department of Neurosurgery, San Salvatore Hospital, L'Aquila
,
Alessandro Ricci
1   Department of Neurosurgery, San Salvatore Hospital, L'Aquila
,
Graziano Taddei
1   Department of Neurosurgery, San Salvatore Hospital, L'Aquila
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Purpose: The world population is aging. As direct consequence, geriatric trauma is increasing both in absolute number and in the proportion of annual admissions causing a challenge for the health-care system worldwide. The aim of this review is to delineate the specific and practice rules for the management of mild brain trauma in the elderly. Methods: Systematic review of the last 15 years literature on mild traumatic brain injury (nTBI) in elderly patients. Results: A total of 68 articles met all eligibility criteria and were selected for the systematic review. We collected 29% high-quality studies and 71% low-quality studies. Conclusion: Clinical advices for a comprehensive management are provided. Current outcome data from mTBIs in the elderly show a condition that cannot be sustained in the future by families, society, and health-care systems. There is a strong need for more research on geriatric mild brain trauma addressed to prevent falls, to reduce the impact of polypharmacy, and to define specific management strategies.

Key-words:

Brain trauma - elderly - head injury - head trauma - mild brain trauma

Financial support and sponsorship

Nil.




Publikationsverlauf

Eingereicht: 05. Mai 2020

Angenommen: 03. Juli 2020

Artikel online veröffentlicht:
16. August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Werman HA, Erskine T, Caterino J, Riebe JF, Valasek T, Members of the Trauma Committee of the State of Ohio EMS Board. Development of statewide geriatric patients trauma triage criteria. Prehosp Disaster Med 2011;26:170-9.
  • 2 Bruns J Jr., Hauser WA. The epidemiology of traumatic brain injury: A review. Epilepsia 2003;44:2-10.
  • 3 de Guise E, LeBlanc J, Dagher J, Tinawi S, Lamoureux J, Marcoux J, et al. Traumatic brain injury in the elderly: A level 1 trauma centre study. Brain INJ 2015;29:558-64.
  • 4 Adams SD, Holcomb JB. Geriatric trauma. Curr Opin Crit Care 2015;21:520-526 doi:10.1097/MCC.3041773041770246.
  • 5 van den Brand CL, Karger LB, Nijman ST, Hunink MG, Patka P, Jellema K. Traumatic brain injury in the Netherlands, trends in emergency department visits, hospitalization and mortality between 1998 and 2012. Eur J Emerg Med 2018;25:355-61.
  • 6 Cetty L, Abdin E, Vaingankar JA, Jeyagurunathan A, Chua BY, Picco L, et al. Prevalence and correlates of traumatic brain injury (TBI) in older adults: Results from the Well being of the Singapore Elderly (WiSE) study. Int Psychogeriatr 2017;29:1899-907.
  • 7 Haring RS, Narang K, Canner JK, Asemota AO, George BP, Selvarajah S, et al. Traumatic brain injury in the elderly: Morbidity and mortality trends and risk factors. J Surg Res 2015;195:1-9.
  • 8 Jiang JY. Head trauma in China. Injury 2013;44:1453-57.
  • 9 Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien) 2006;148:255 68; discussion 268.
  • 10 Servadei F, Teasdale G, Merry G, Societies NCotWFoN. Defining acute mild head injury in adults: A proposal based on prognostic factors, diagnosis, and management. J Neurotrauma 2001;18:657-64.
  • 11 Mosenthal AC, Livingston DH, Lavery RF, Knudson MM, Lee S, Morabito D, et al. The effect of age on functional outcome in mild traumatic brain injury: 6 month report of a prospective multicenter trial. J Trauma 2004;56:1042-8.
  • 12 Polidoro A, Dornbusch T, Vestri A, Di Bona S, Alessandri C. Frailty and disability in the elderly: A diagnostic dilemma. Arch Gerontol Geriatr 2011;52:e75-78.
  • 13 Carroll L, Cassidy JD, Holm L, Kraus J, Coronado V. Methodological issues and research recommendations for mild traumatic brain injury: The who collaborating centre task force on mild traumatic brain injury. J Rehabil Med 2004;36:113-25.
  • 14 Kristman VL, Borg J, Godbolt AK, Salmi LR, Cancelliere C, Carroll LJ, et al. Methodological issues and research recommendations for prognosis after mild traumatic brain injury: Results of the international collaboration on mild traumatic brain injury prognosis. Arch Phys Med Rehabil 2014;95:S265-77.
  • 15 Kozar RA, Arbabi S, Stein DM, Shackford SR, Barraco RD, Biffl WL, et al. Injury in the aged: Geriatric trauma care at the crossroads. J Trauma Acute Care Surg 2015;78:1197-209.
  • 16 Gaastra B, Longworth A, Matta B, Snelson C, Whitehouse T, Murphy N, et al. The ageing population is neglected in research studies of traumatic brain injury. Br J Neurosurg 2016;30:221-6.
  • 17 Cheng PL, Lin HY, Lee YK, Hsu CY, Lee CC, Su YC. Higher mortality rates among the elderly with mild traumatic brain injury: A nationwide cohort study. Scand J Trauma Resusc Emerg Med 2014;22:7.
  • 18 Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol 2009;62:e1-34.
  • 19 Sauaia A, Moore EE, Crebs JL, Maier RV, Hoyt DB, Shackford SR. Evidence level of individual studies: A proposed framework for surgical research. J Trauma Acute Care Surg 2012;72:1484-90.
  • 20 Evans D, Pester J, Vera L, Jeanmonod D, Jeanmonod R. Elderly fall patients triaged to the trauma bay: Age, injury patterns, and mortality risk. Am J Emerg Med 2015;33:1635-8.
  • 21 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:e0175868.
  • 22 Karibe H, Hayashi T, Narisawa A, Kameyama M, Nakagawa A, Tominaga T. Clinical characteristics and outcome in elderly patients with traumatic brain injury: For establishment of management strategy. Neurol Med Chir (Tokyo) 2017;57:418-25.
  • 23 Ramanathan DM, McWilliams N, Schatz P, Hillary FG. Epidemiological shifts in elderly traumatic brain injury: 18 year trends in Pennsylvania. J Neurotrauma 2012;29:1371-8.
  • 24 Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother 2007;5:345-51.
  • 25 Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickizer SW, et al. Potentially inappropriate medication use in the community dwelling elderly: Findings from the 19.
  • 26 Krishnamoorthy V, Distelhorst JT, Vavilala MS, Thompson H. Traumatic brain injury in the elderly: Burden, risk factors, and prevention. J Trauma Nurs 2015;22:204-08.
  • 27 Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C. Prevention of falls in the elderly trial (PROFET): A randomised controlled trial. Lancet (London, England) 1999;353:93-7.
  • 28 Callaway DW, Wolfe R. Geriatric trauma. Emerg Med Clin North Am 2007;25:837-60.
  • 29 Rau CS, Wu SC, Chen YC, Chien PC, Hsieh HY, Kuo PJ, et al. Effect of age on glasgow coma scale in patients with moderate and severe traumatic brain injury: An approach with propensity score matched population. Int J Environ Res Public Health 2017;14:1378. doi:10.3390/ijerph1411137.
  • 30 Salottolo K, Levy AS, Slone DS, Mains CW, Bar Or D. The effect of age on Glasgow coma scale score in patients with traumatic brain injury. JAMA Surg 2014;149:727.
  • 31 Mack LR, Chan SB, Silva JC, Hogan TM. The use of head computed tomography in elderly patients sustaining minor head trauma. J Emerg Med 2003;24:157-62.
  • 32 Gangavati AS, Kiely DK, Kulchycki LK, Wolfe RE, Mottley JL, Kelly SP, et al. Prevalence and characteristics of traumatic intracranial hemorrhage in elderly fallers presenting to the emergency department without focal findings: Intracranial hemorrhage in elderly fallers. J Am Geriatr Soc 2009;57:1470-4.
  • 33 Jagoda AS, Bazarian JJ, Bruns JJ, Cantrill SV, Gean AD, Howard PK, et al. Clinical policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med 2008;52:714-48.
  • 34 Smits M, Dippel DW, de Haan GG, Dekker HM, Vos PE, Kool DR, et al. External validation of the Canadian CT head rule and the new Orleans criteria for CT scanning in patients with minor head injury. JAMA 2005;294:1519-25.
  • 35 Vos PE, Alekseenko Y, Battistin L, Ehler E, Gerstenbrand F, Muresanu DF, et al. Societies EFoN. Mild traumatic brain injury. Eur J Neurol 2012;19:191-8.
  • 36 Clement CM, Stiell IG, Schull MJ, Rowe BH, Brison R, Lee JS, et al. Clinical features of head injury patients presenting with a glasgow coma scale score of 15 and who require neurosurgical intervention. Ann Emerg Med 2006;48:245-51.
  • 37 Itshayek E, Rosenthal G, Fraifeld S, Perez Sanchez X, Cohen JE, Spektor S. Delayed posttraumatic acute subdural hematoma in elderly patients on anticoagulation. Neurosurgery 2006;58:A851-6.
  • 38 Campiglio L, Bianchi F, Cattalini C, Belvedere D, Rosci CE, Casellato CL, et al. Mild brain injury and anticoagulants: Less is enough. Neurol Clin Pract 2017;7:296-305.
  • 39 Kaen A, Jimenez Roldan L, Arrese I, Delgado MA, Lopez PG, Alday R, et al. The value of sequential computed tomography scanning in anticoagulated patients suffering from minor head injury. J Trauma 2010;68:895-8.
  • 40 Miller J, Lieberman L, Nahab B, Hurst G, Gardner Gray J, Lewandowski A. Delayed intracranial hemorrhage in the anticoagulated patient: A systematic review. J Trauma Acute Care Surg 2015;79:310-3.
  • 41 Nishijima DK, Offerman SR, Ballard DW, Vinson DR, Chettipally UK, Rauchwerger AS, et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med 2012;59:460-8.e467.
  • 42 Scantling D, Fischer C, Gruner R, Teichman A, McCracken B, Eakins J. The role of delayed head CT in evaluation of elderly blunt head trauma victims taking antithrombotic therapy. Eur J Trauma Emerg Surg 2017;43:741-6.
  • 43 Swap C. Risk of delayed intracerebral hemorrhage in anticoagulated patients after minor head trauma: The role of repeat cranial computed tomography. Perm J 2016; 20:14-6. doi: 10.7812/TPP/15-095.
  • 44 Chenoweth JA, Gaona SD, Faul M, Holmes JF, Nishijima DK, Consortium ft SC. Incidence of delayed intracranial hemorrhage in older patients after blunt head trauma. JAMA Surg 2018;153:570.
  • 45 Pieracci FM, Eachempati SR, Shou J, Hydo LJ, Barie PS. Degree of anticoagulation, but not warfarin use itself, predicts adverse outcomes after traumatic brain injury in elderly trauma patients. J Trauma 2007;63:525-30.
  • 46 Ritchie PD, Cameron PA, Ugoni AM, Kaye AH. A study of the functional outcome and mortality in elderly patients with head injuries. J Clin Neurosci 2000;7:301-4.
  • 47 Collins CE, Witkowski ER, Flahive JM, Anderson FA, Santry HP. Effect of preinjury warfarin use on outcomes after head trauma in Medicare beneficiaries. Am J Surg 2014;208:544-9.e541.
  • 48 Scotti P, Séguin C, Lo BW, de Guise E, Troquet JM, Marcoux J. Antithrombotic agents and traumatic brain injury in the elderly population: Hemorrhage patterns and outcomes. J Neurosurg 2019; 5:1-10.
  • 49 Kobayashi L, Barmparas G, Bosarge P, Brown CV, Bukur M, Carrick MM, et al.Group AMPOSoTPoNOAS. Novel oral anticoagulants and trauma: The results of a prospective American Association for the Surgery of Trauma Multi Institutional Trial. J Trauma Acute Care Surg 2017;82:827-35.
  • 50 Riccardi A, Spinola B, Minuto P, Ghinatti M, Guiddo G, Malerba M, et al. Intracranial complications after minor head injury (MHI) in patients taking vitamin K antagonists (VKA) or direct oral anticoagulants (DOACs). Am J Emerg Med 2017;35:1317-9.
  • 51 Julien J, Alsideiri G, Marcoux J, Hasen M, Correa JA, Feyz M, et al. Antithrombotic agents intake prior to injury does not affect outcome after a traumatic brain injury in hospitalized elderly patients. J Clin Neurosci 2017;38:122-5.
  • 52 Ivascu FA, Howells GA, Junn FS, Bair HA, Bendick PJ, Janczyk RJ. Rapid warfarin reversal in anticoagulated patients with traumatic intracranial hemorrhage reduces hemorrhage progression and mortality. J Trauma 2005;59:1131-7.
  • 53 Grandhi R, Harrison G, Voronovich Z, Bauer J, Chen SH, Nicholas D, et al. Preinjury warfarin, but not antiplatelet medications, increases mortality in elderly traumatic brain injury patients. J Trauma Acute Care Surg 2015;78:614-21.
  • 54 Mahler B, Carlsson S, Andersson T, Adelöw C, Ahlbom A, Tomson T. Unprovoked seizures after traumatic brain injury: A population based case control study. Epilepsia 2015;56:1438-44.
  • 55 Motika PV, Spencer DC. Treatment of epilepsy in the elderly. Curr Neurol Neurosci Rep 2016;16:96. doi:10.1007/s11910-016-0696-8.
  • 56 Lai Fung L, Wai Man L, Wong HT, Yuen WK, Leung GK. Outcome after operative intervention for traumatic brain injuries in the elderly. Asian J Neurosurg 2017;12:37.
  • 57 Flaada JT, Leibson CL, Mandrekar JN, Diehl N, Perkins PK, Brown AW, et al. Relative risk of mortality after traumatic brain injury: A population based study of the role of age and injury severity. J Neurotrauma 2007;24:435-45.
  • 58 Susman M, DiRusso SM, Sullivan T, Risucci D, Nealon P, Cuff S, et al. Traumatic brain injury in the elderly: Increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma 2002;53:219-23; discussion 223-4.
  • 59 Scalea TM, Simon HM, Duncan AO, Atweh NA, Sclafani SJ, Phillips TF, et al. Geriatric blunt multiple trauma: Improved survival with early invasive monitoring. J Trauma 1990;30:129 34; discussion 134-6.
  • 60 Pedersen AR, Severinsen K, Nielsen JF. The effect of age on rehabilitation outcome after traumatic brain injury assessed by the functional independence measure (FIM). Neurorehabil Neural Repair 2015;29:299-307.
  • 61 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;82:1300-6.