Citation

Stocchetti N, Paternò R, Citerio G, Beretta L, Colombo A. J. Neurotrauma 2012; 29(6): 1119-1125.

Affiliation

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NeuroIntensive Care Unit, Milan, Italy; stocchet@policlinico.mi.it.

Copyright

(Copyright © 2012, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2011.1995

PMID

22220762

Abstract

Epidemiology of traumatic brain injury (TBI) is changing in several western countries, with an increasing proportion of elderly TBI patients admitted to ICU. We describe a series of 1366 adult patients admitted to 3 neuro-ICUs in which 44% of cases were 50 years or older. The health status before trauma (rated using the APACHE score) was worse in older patients. Six-hundred-four patients had emergency removal of intracranial masses, with extradural hematomas more frequent in young cases and subdural in older patients. Outcomes were classified, according to the Glasgow Outcome Scale (GOS) 6 months post-trauma, as ''favorable'' (GOS score 4- 5), or ''unfavorable'' (GOS score 1-3). Favorable outcomes were achieved by 50% of patients, but the proportions of unfavorable outcomes rose with age. Mortality was the main cause of unfavorable outcomes six months after injury in older patients. Logistic regression analysis indicates that several parameters independently contributed to outcome, including the motor component of the GCS, pupils, CT findings and early hypotension. Additionally, the odds ratios were very high for age and health status before TBI. Patients admitted to ICU are increasingly older, with co-morbidities, and with specific types of intracranial lesion. Early rescue, surgical treatment and intensive care of these patients may produce excellent results up to the age of 59 years, with favorable outcomes still possible for 39% of cases aged 60 to 69 years, without an excessive burden of severely disabled patients.

Language: en