TY - JOUR
T1 - Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury
AU - Ostermann, Roman C
AU - Joestl, Julian
AU - Tiefenboeck, Thomas M
AU - Lang, Nikolaus
AU - Platzer, Patrick
AU - Hofbauer, Marcus
N1 - Publisher Copyright:
© 2018 The Author(s).
PY - 2018/11/3
Y1 - 2018/11/3
N2 - BACKGROUND: Traumatic brain injury (TBI), particularly in the elderly patient population, is known to be the single largest cause of death and disability worldwide. The purpose of this retrospective study was to evaluate clinical factors predicting poor outcome with special emphasis on the impact of respiratory failure (RF) on mortality in elderly patients with isolated severe TBI.METHODS: All elderly patients (age ≥ 65 years) with isolated severe head injury, admitted to this level I trauma center, during a period of 18 years (from January 1992 to December 2010) were identified from the trauma registry. The medical records were reviewed for demographics, mechanism of injury (MOI), GCS score at admission, RF, pupillary light reflex (LR), CT findings (subdural hematoma, subarachnoid hematoma, edema, midline-shift), and whether there was conservative treatment or surgical intervention and the Glasgow Outcome Score (GOS) at hospital discharge. Stepwise logistic regression analysis was used to identify risk factors for a poor prognosis and outcome.RESULTS: The following variables influenced the mortality: respiratory failure, pupillary response, and the injury severity score (ISS). A significant increased risk of death was also found for patients with a midline shift of over 15 mm.CONCLUSIONS: The present study predicts a strong correlation between respiratory failure, pathological pupillary response, a higher ISS, and substantial midline shift with poor outcomes in elderly patients sustaining an isolated severe TBI.TRIAL REGISTRATION: Clinical trials: ID: NCT02386865 . Registered 12 March 2015-retrospectively registered.
AB - BACKGROUND: Traumatic brain injury (TBI), particularly in the elderly patient population, is known to be the single largest cause of death and disability worldwide. The purpose of this retrospective study was to evaluate clinical factors predicting poor outcome with special emphasis on the impact of respiratory failure (RF) on mortality in elderly patients with isolated severe TBI.METHODS: All elderly patients (age ≥ 65 years) with isolated severe head injury, admitted to this level I trauma center, during a period of 18 years (from January 1992 to December 2010) were identified from the trauma registry. The medical records were reviewed for demographics, mechanism of injury (MOI), GCS score at admission, RF, pupillary light reflex (LR), CT findings (subdural hematoma, subarachnoid hematoma, edema, midline-shift), and whether there was conservative treatment or surgical intervention and the Glasgow Outcome Score (GOS) at hospital discharge. Stepwise logistic regression analysis was used to identify risk factors for a poor prognosis and outcome.RESULTS: The following variables influenced the mortality: respiratory failure, pupillary response, and the injury severity score (ISS). A significant increased risk of death was also found for patients with a midline shift of over 15 mm.CONCLUSIONS: The present study predicts a strong correlation between respiratory failure, pathological pupillary response, a higher ISS, and substantial midline shift with poor outcomes in elderly patients sustaining an isolated severe TBI.TRIAL REGISTRATION: Clinical trials: ID: NCT02386865 . Registered 12 March 2015-retrospectively registered.
KW - Aged
KW - Aged, 80 and over
KW - Austria/epidemiology
KW - Brain Injuries, Traumatic/complications
KW - Emergency Treatment
KW - Female
KW - Humans
KW - Male
KW - Prognosis
KW - Respiratory Insufficiency/etiology
KW - Retrospective Studies
KW - Risk Factors
KW - Isolated severe traumatic brain injuries (TBI)
KW - Outcome prediction
KW - Elderly patients
KW - Respiratory failure
UR - http://www.scopus.com/inward/record.url?scp=85055931650&partnerID=8YFLogxK
U2 - 10.1186/s13018-018-0975-y
DO - 10.1186/s13018-018-0975-y
M3 - Journal article
C2 - 30390698
SN - 1749-799X
VL - 13
SP - 277
JO - Journal of Orthopaedic Surgery and Research
JF - Journal of Orthopaedic Surgery and Research
IS - 1
M1 - 277
ER -