Research Reports - Traumatic brain injury in the elderly: considerations in a series of 103 patients older than 70

J Neurosurg Sci. 2012 Sep;56(3):231-7

Gaetani P, Revay M, Sciacca S, Pessina F, Aimar E, Levi D, Morenghi E

AIM: Mortality and morbidity due to brain injury in the elderly population is a
growing clinical problem: among older patients, those >70 years have a
considerably higher risk both in terms of mortality and morbidity. Thereafter,
the reasons influencing outcome have not been clearly examined: in the present
study we addressed these questions considering the main clinical characteristics
exerting a significant impact on the outcome of patients aged > 70, with emphasis
for the severity of brain injury and anticoagulant (CAW) treatments.
METHODS: We performed a retrospective analysis of 103 consecutive isolated head
injury patients older than 70, admitted at our Department in the period November
2004-November 2009. The clinical variables considered were as follow: age, sex,
type of TBI, GCS, pre-TBI use of anti-coagulants (aspirin, warfarin,
clopidogrel), INR at admission (INR values were subdivided in values >1.25 as at
risk for hemorrhagic events and <1.25 as normal), initial CT scan classification
looking at the presence of subarachnoid hemorrhage (t-SAH) or mass lesions; the
main outcome measure was the Glasgow Outcome Scale.
RESULTS: The most frequent cause of TBI was accidental fall (65%): 39 were in CAW
therapies and in 36 cases the cause of falling down injury was recorded due to a
sincopal event (arterial hypotension, atrial fibrillation); in the older patients
an accidental fall is significantly related to the TBI, while in the patients
aged 70-75 years, TBI is related to a traffic accident (P=0.002). Moreover the
cause of TBI correlates with the CAW treatment, the accidental fall being
significantly more frequent in patients in CAW treatment (P=0.003). Overall
mortality rate is significantly related to an elevated INR class, to presence of
t-SAH (16/50 patients) and subdural hematoma (26/46).
CONCLUSION: The results of the present study show that in a population of
patients aged > 70, TBI is a high risk event if patient has concurrent treatment
with CAW therapies and if an accidental fall is the cause of TBI. In these cases
the finding of t-SAH represents a high-risk parameter for mortality but not for
morbidity.
 

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