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MANAGEMENT AND HOSPITAL OUTCOME OF THE SEVERELY HEAD INJURED ELDERLY PATIENT
Author(s) -
Mitra Biswadev,
Cameron Peter A.,
Gabbe Belinda J.,
Rosenfeld Jeffrey V.,
Kavar Bhadrakant
Publication year - 2008
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2008.04579.x
Subject(s) - medicine , glasgow coma scale , head injury , demographics , retrospective cohort study , population , glasgow outcome scale , psychological intervention , pediatrics , mortality rate , surgery , emergency medicine , demography , environmental health , psychiatry , sociology
Severe traumatic head injury in the elderly has been associated with poor outcomes. However, there is currently no consensus to direct management in these patients. This study outlines the demographics, injury characteristics, management and outcome of the elderly trauma patients with severe head injury across a defined population. Materials and Methods: A retrospective review of all elderly patients (age >64 years) with a Glasgow Coma Scale (GCS) score of 8 or less, and confirmed intracranial pathology or fractured skull, was undertaken over a period of 40 months from July 2001 to September 2005. Data on patient demographics, injury cause, presenting clinical features and interventions were collected. In‐hospital mortality was used as the primary outcome. Results: There were 96 patients who met the inclusion criteria. One‐third of the patients were managed palliatively, one‐third supportively without surgery and another third underwent surgery. Overall mortality was 70.8% ( n = 68). Older age and brainstem injuries were identified as independent predictors of mortality. Mortality was reported in all patients aged 85 years or older. Conclusions: Although overall outcomes were poor, careful consideration should be given to active treatment as favourable outcomes were possible even in the presence of extremely low GCS scores. Prediction of outcome on the basis of age and anatomical diagnoses may help in this decision‐making.