Risk factor assessment and outcome analysis in elderly (≥60 years) patients of severe head injury
Keywords:Elderly, GCS, Head injury, TBI
Background: Incidence of head injuries is rising all over the world. Only few studies have been performed regarding severe head injury in elderly people. We aimed to study the epidemiology, mode of injury, management, co-morbidity, associated injuries which affects the outcomes. Severe head injury is unconsciousness >6 hours and GCS 3-8. In India 6.63% of the total population above 60 years is considered elderly. Falls are the major contributor to TBI in elderly but in India RTA is still the main contributor. Outcomes of TBI, both in terms of mortality and function, are significantly worse in the elderly.
Methods: Objective of this study was to find the risk factors affecting the outcome in severe head injury. This was a prospective study and carried on 56 patient in Department of surgery of M. L. N. Medical College, Prayagraj from September 2018 to September 2019.
Results: Male were most commonly affected but the gender had no significant prognostic effect on outcome. RTA were the most common cause of head injury. GCS at admission was directly related to outcome. Bilateral non-reactive pupils had poor outcome. Type of hematoma and midline shift had also affected the outcome. Operated cases had better outcome than non-operated cases. Any associated injury with TBI had worsened the outcome in patient. Any co-morbid condition associated with brain injury had slower recovery and worsen the outcome. Overall mortality in this series was 64.28% and unfavourable outcome was 76.79%.
Conclusions: Severe head injury in elderly people had worst outcome.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81-4.
Borkar SA, Sinha S, Agrawal D, Satyarthee GD, Gupta D, Mahapatra AK. 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.
Anderson SI, Housley AM, Jones PA, Slattery J, Miller JD. Glasgow Outcome Scale: an inter-rater reliability study. Brain Inj. 1993;7:309-17.
Kumar L, Agrawal S, Singh T, Garg R. Patterns of head injury at tertiary care hospital. Int J Scient Study. 2014;(5):5-8.
Khadka B, Deka PK, Karki A. Role of CT (Computed Tomography) in head injury. J Manmohan Memo Inst Health Sci. 2016;2:45-52.
Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res. 2002;24(1):24-8.
Davis T, Ings A. Head injury: triage, assessment, investigation and early management of head injury in children, young people and adults (NICE guideline CG 176). Arch Dis Child Educ Pract Ed. 2015;100(2):97-100.
Faeadh MH. Functional outcome off severe closed head injury: A case series study of 50 patients. Tikrit Med J. 2011;17(2):78-99.
Agrawal A, Galwankar S, Kapil V, Coronado V, Basavaraju SV, McGuire LC, et al. Epidemiology and clinical characteristics of traumatic brain injuries in a rural setting in Maharashtra, India. 2007-2009. Int J Crit Illn Inj Sci. 2012;2(3):167-71.
Hoffmann M, Lefering R, Rueger JM, Kolb JP, Izbicki JR, Ruecker AH, et al. Pupil evaluation in addition to Glasgow Coma Scale components in prediction of traumatic brain injury and mortality. Br J Surg. 2012;99(1):122-30.
Tomar SS, Bhargava A, Reddy N. Significance of computed tomography scans in head injury. Open J Clin Diagn. 2013;3:109-14.
Rodríguez M. Predicting mortality from head injury: experience of Sancti Spíritus Province, Cuba. MEDICC Rev. 2013;15(3):30-3.
Pandey S, Sharma V, Singh K, Chauhan RS. Bilateral traumatic intracranial haematomas and its outcome: a retrospective study. Indian J Surg. 2015;79(1):19-23.
Salama DI, Maray AG, Hamed W. Identification of clinical and radiological predictors of outcome in head trauma patients in the emergency departement. Biolife. 2015;3(3):644-52.
Kumar CS, Prasad KS, Rajasekhar B, Raman BV. A study on various clinical presentations of extradural hemorrhage, factors affecting treatment and early outcome. Int J Res Med Sci. 2017;5(4):1288-93.
Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF, et al. Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg. 2003;99(4):666-73.
Ostermann RC, Joestl J, Tiefenboeck TM, Lang N, Platzer P, Hofbauer M. Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury. J Orthopaed Surg Res. 2018;13(1):277.
So WH, Chan HF, Li MK. Investigation of risk factors of geriatric patients with significant brain injury from ground-level fall: A retrospective cohort study in a local accident and emergency department setting. Hong Kong J Emerg Med. 2018;25(6):305-12.
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. Neurologia Medico-Chirurgica. 2017;57(8):418-25.