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Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care

BACKGROUND: The probability of favorable outcome after traumatic brain injury (TBI) decreases with age. Elderly, ≥ 60 years, are an increasing part of our population. Recent studies have shown an increase of favorable outcome in elderly over time. However, the optimal patient selection and neurointe...

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Autores principales: Lenell, Samuel, Nyholm, Lena, Lewén, Anders, Enblad, Per
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525667/
https://www.ncbi.nlm.nih.gov/pubmed/30980243
http://dx.doi.org/10.1007/s00701-019-03893-6
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author Lenell, Samuel
Nyholm, Lena
Lewén, Anders
Enblad, Per
author_facet Lenell, Samuel
Nyholm, Lena
Lewén, Anders
Enblad, Per
author_sort Lenell, Samuel
collection PubMed
description BACKGROUND: The probability of favorable outcome after traumatic brain injury (TBI) decreases with age. Elderly, ≥ 60 years, are an increasing part of our population. Recent studies have shown an increase of favorable outcome in elderly over time. However, the optimal patient selection and neurointensive care (NIC) treatments may differ in the elderly and the young. The aims of this study were to examine outcome in a larger group of elderly TBI patients receiving NIC and to identify demographic and treatment related prognostic factors. METHODS: Patients with TBI ≥ 60 years receiving NIC at our department between 2008 and 2014 were included. Demographics, co-morbidity, admission characteristics, and type of treatments were collected. Clinical outcome at around 6 months was assessed. Potential prognostic factors were included in univariate and multivariate regression analysis with favorable outcome as dependent variable. RESULTS: Two hundred twenty patients with mean age 70 years (median 69; range 60–87) were studied. Overall, favorable outcome was 46% (Extended Glasgow Outcome Scale (GOSE) 5–8), unfavorable outcome 27% (GOSE 2–4), and mortality 27% (GOSE 1). Significant independent negative prognostic variables were high age (p < 0.05), multiple injuries (p < 0.05), GCS M ≤ 3 on admission (p < 0.05), and mechanical ventilation (p < 0.001). CONCLUSIONS: Overall, the elderly TBI patients > 60 years receiving modern NIC in this study had a fair chance of favorable outcome without large risks for severe deficits and vegetative state, also in patients over 75 years of age. High age, multiple injuries, GCS M ≤ 3 on admission, and mechanical ventilation proved to be independent negative prognostic factors. The results underline that a selected group of elderly with TBI should have access to NIC.
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spelling pubmed-65256672019-06-05 Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care Lenell, Samuel Nyholm, Lena Lewén, Anders Enblad, Per Acta Neurochir (Wien) Original Article - Brain trauma BACKGROUND: The probability of favorable outcome after traumatic brain injury (TBI) decreases with age. Elderly, ≥ 60 years, are an increasing part of our population. Recent studies have shown an increase of favorable outcome in elderly over time. However, the optimal patient selection and neurointensive care (NIC) treatments may differ in the elderly and the young. The aims of this study were to examine outcome in a larger group of elderly TBI patients receiving NIC and to identify demographic and treatment related prognostic factors. METHODS: Patients with TBI ≥ 60 years receiving NIC at our department between 2008 and 2014 were included. Demographics, co-morbidity, admission characteristics, and type of treatments were collected. Clinical outcome at around 6 months was assessed. Potential prognostic factors were included in univariate and multivariate regression analysis with favorable outcome as dependent variable. RESULTS: Two hundred twenty patients with mean age 70 years (median 69; range 60–87) were studied. Overall, favorable outcome was 46% (Extended Glasgow Outcome Scale (GOSE) 5–8), unfavorable outcome 27% (GOSE 2–4), and mortality 27% (GOSE 1). Significant independent negative prognostic variables were high age (p < 0.05), multiple injuries (p < 0.05), GCS M ≤ 3 on admission (p < 0.05), and mechanical ventilation (p < 0.001). CONCLUSIONS: Overall, the elderly TBI patients > 60 years receiving modern NIC in this study had a fair chance of favorable outcome without large risks for severe deficits and vegetative state, also in patients over 75 years of age. High age, multiple injuries, GCS M ≤ 3 on admission, and mechanical ventilation proved to be independent negative prognostic factors. The results underline that a selected group of elderly with TBI should have access to NIC. Springer Vienna 2019-04-13 2019 /pmc/articles/PMC6525667/ /pubmed/30980243 http://dx.doi.org/10.1007/s00701-019-03893-6 Text en © The Author(s) 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article - Brain trauma
Lenell, Samuel
Nyholm, Lena
Lewén, Anders
Enblad, Per
Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care
title Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care
title_full Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care
title_fullStr Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care
title_full_unstemmed Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care
title_short Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care
title_sort clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care
topic Original Article - Brain trauma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525667/
https://www.ncbi.nlm.nih.gov/pubmed/30980243
http://dx.doi.org/10.1007/s00701-019-03893-6
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