Research Reports - Age-related outcome of patients after traumatic brain injury

Minerva Anestesiol. 2017 Jun 22. doi: 10.23736/S0375-9393.17.11837-7. [Epub ahead
of print]

Erlebach R(1), Pagnamenta A(2), Klinzing S(1), Stretti F(1)(3), Cottini S(1),
Schüpbach R(1), Steiger P(1), Brandi G(4).

BACKGROUND: Study-purpose is to analyze clinical features of patients with
traumatic brain injury (TBI), their age-related outcomes and determinants of
long- term outcome.
METHODS: This retrospective cohort study was conducted in a level I University
Swiss trauma center. Consecutive patients with moderate to severe TBI admitted
for more than 48 hours to the Intensive Care Unit were included. Patients' and
trauma characteristics, management during ICU-stay, prognostic scores and long-
term outcomes were analyzed.
RESULTS: Hundred-seventy-four patients (72% males, mean age 49 years) were
divided in 3 age groups: young (≤39 years, n=69, 39.7%), middle aged (40-64
years, n=55, 31.6%), and elderly (≥65 years, n=50, 28.7%). In elderly patients,
falls (62%) were the most common cause of TBI. Overall ICU-mortality was 15% with
no difference among age groups. Within six-months after TBI, 80% of elderly
patients presented unfavorable outcomes. Age, pre-existing cardiovascular
disease, use of anticoagulants and/or antiplatelet agents, abnormal pupillary
reactivity, a high score in Marshall CT classification, and a higher glucose
level were associated with unfavorable outcomes in a univariable logistic
regression. In a multivariable logistic regression, age and abnormal pupillary
reactivity were identified as independent risk factors for unfavourable outcomes,
while presence of epidural hematoma and higher hemoglobin levels were predictors
for favorable outcomes.
CONCLUSIONS: Older patients are at higher risk for long-term unfavorable outcomes
than younger patients. Use of anticoagulants and/or antiplatelet agents and lower
hemoglobin levels during rescue phase are associated with unfavorable long-term
outcomes. Falls prevention in the elderly should especially be target of
intervention programs. 

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