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Abstract
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Traumatic Brain Injury (TBI) is a global health burden. It is estimated that more than 69 million (95% confidence interval 64-74 million) individuals are estimated to suffer from TBI from all causes each year, with the Southeast Asian and Western Pacific regions experiencing the greatest overall burden of disease [1]. Admission patterns may differ by age [2], with the very young [3] and the elderly [4] at high risk for TBI. Falls are the most common mechanism of injury in 0-4 year olds [5] and the elderly [6].
Different age groups may not receive the same diagnostic testing and therapeutic interventions. Intracranial pressure monitoring may be infrequently used in children [7], despite the publication of pediatric Brain Trauma Foundation guidelines. The management intensity (defined as trauma team activation, advanced TBI imaging, invasive intracranial pressure monitoring, ventilator treatment, surgical evacuation of mass lesions, and decompressive craniectomy) of hospitalized patients with TBI may be decreased with advanced age, regardless of illness severity. Low management intensity may be associated with an increased risk of 30-day mortality [8]. Shimoda et al. has reported similar observations from a study using the Japan Neurotrauma Data Bank [9].
The outcomes of TBI vary with age [10]. In a study by Garza et. al, the >65 age group had a four-fold increased risk for unfavorable outcomes compared to the 18-34 group, this effect being most pronounced after mild TBI [2]. However, recent trends in the reduction in in-hospital mortality in moderate-severe TBI patients from the U.S may be encouraging [11]. TBI severity, pupillary reactivity, coagulation status, the need for blood product transfusion and acute bleeding, as well as basal cisterns obliteration found in head CT, may be associated with outcome of elderly patients with TBIs that needed surgical management [12].
Advancements in our understanding of the epidemiology and pathophysiology of TBI have resulted in evidence-based guidelines for pre-hospital [13] and intra-hospital care in adults [14] and children [15]. The evolution of the Brain Trauma Foundation's TBI guidelines [16] and their correlation with published TBI research [17] highlight ongoing efforts to advance the quality of evidence for TBI care. Some of the advancements in TBI care include the Level I evidence against the use of corticosteroids to improve clinical outcomes, based on the results of the CRASH-1 trial [18]. The6 fourth edition of the Brain Trauma Foundation Guidelines has recommended blood pressure targets for different age groups (≥100 mm Hg for patients aged 50-69 years and ≥110 mm Hg for patients aged 15-59 or above 70 years) [14]. The recently published CRASH-3 trial indicates that tranexamic acid is safe in patients with TBI, and that treatment within three hours of injury reduces head injury-related death...
Language: en |