TY - JOUR
T1 - Traumatic brain injury in the elderly
T2 - Increased mortality and worse functional outcome at discharge despite lower injury severity
AU - Susman, Mark
AU - DiRusso, Stephen M.
AU - Sullivan, Thomas
AU - Risucci, Donald
AU - Nealon, Peter
AU - Cuff, Sara
AU - Haider, Adil
AU - Benzil, Deborah
AU - Debra Kuhls, Kimberly Nagy
AU - Healey, Mark A.
AU - Borzotta, Anthony P.
AU - DiRusso, Stephen M.
PY - 2002/8
Y1 - 2002/8
N2 - Objective: The purpose of this study was to compare data obtained from a statewide data set for elderly patients (age > 64 years) that presented with traumatic brain injury with data from nonelderly patients (age > 15 and > 65 years) with similar injuries. Methods: The New York State Trauma Registry from January 1994 through December 1995, from trauma centers and community hospitals excluding New York City (45,982 patients), was examined. Head-injured patients were identified by International Classification of Diseases, Ninth Revision diagnosis codes. A relative head injury severity scale (RHISS) was constructed on the basis of groups of these codes (range, 0 = none to 3 = severe). Comparisons were made with nonelderly patients for mortality, Glasgow Coma Scale (GCS) score at admission and discharge, Injury Severity Score, New Injury Severity Score, and RHISS. Outcome was assessed by a Functional Independence Measure score in three major domains: expression, locomotion, and feeding. Data were analyzed by the X2 test and Mann-Whitney U test, with p <0.05 considered significant. Results: There were 11,772 patients with International Classification of Diseases, Ninth Revision diagnosis of head injury, of which 3,244 (27%) were elderly. There were more male subjects in the non-elderly population (78% male subjects) compared with the elderly population (50% men). Mortality was 24.0% in the elderly population compared with 12.8% in the nonelderly population (risk ratio, 2.2; 95% confidence interval, 1.99-2.43). The elderly nonsurvivors were statistically older, and mortality rate increased with age. Stratified by GCS score, there was a higher percentage of nonsurvivors in the elderly population, even in the group with only moderately depressed GCS score (GCS score of 13-15; risk ratio, 7.8; 95% confidence interval, 6.1-9.9 for elderly vs. nonelderly). Functional outcome in all three domains was significantly worse in the elderly survivors compared with the nonelderly survivors. Conclusion. Elderly traumatic brain injury patients have a worse mortality and functional outcome than nonelderly patients who present with head injury even though their head injury and overall injuries are seemingly less severe.
AB - Objective: The purpose of this study was to compare data obtained from a statewide data set for elderly patients (age > 64 years) that presented with traumatic brain injury with data from nonelderly patients (age > 15 and > 65 years) with similar injuries. Methods: The New York State Trauma Registry from January 1994 through December 1995, from trauma centers and community hospitals excluding New York City (45,982 patients), was examined. Head-injured patients were identified by International Classification of Diseases, Ninth Revision diagnosis codes. A relative head injury severity scale (RHISS) was constructed on the basis of groups of these codes (range, 0 = none to 3 = severe). Comparisons were made with nonelderly patients for mortality, Glasgow Coma Scale (GCS) score at admission and discharge, Injury Severity Score, New Injury Severity Score, and RHISS. Outcome was assessed by a Functional Independence Measure score in three major domains: expression, locomotion, and feeding. Data were analyzed by the X2 test and Mann-Whitney U test, with p <0.05 considered significant. Results: There were 11,772 patients with International Classification of Diseases, Ninth Revision diagnosis of head injury, of which 3,244 (27%) were elderly. There were more male subjects in the non-elderly population (78% male subjects) compared with the elderly population (50% men). Mortality was 24.0% in the elderly population compared with 12.8% in the nonelderly population (risk ratio, 2.2; 95% confidence interval, 1.99-2.43). The elderly nonsurvivors were statistically older, and mortality rate increased with age. Stratified by GCS score, there was a higher percentage of nonsurvivors in the elderly population, even in the group with only moderately depressed GCS score (GCS score of 13-15; risk ratio, 7.8; 95% confidence interval, 6.1-9.9 for elderly vs. nonelderly). Functional outcome in all three domains was significantly worse in the elderly survivors compared with the nonelderly survivors. Conclusion. Elderly traumatic brain injury patients have a worse mortality and functional outcome than nonelderly patients who present with head injury even though their head injury and overall injuries are seemingly less severe.
KW - Closed head injury
KW - Elderly
KW - Outcome
KW - Trauma
KW - Traumatic brain injury
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M3 - Article
C2 - 12169925
AN - SCOPUS:0036686065
SN - 1079-6061
VL - 53
SP - 219
EP - 224
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 2
ER -