Modelos pronósticos en el traumatismo craneoencefálico grave

Traumatic brain injury in the new millennium: new population and new management

INTRODUCTION

Traumatic brain injury (TBI) is one of the leading causes of death and disability globally. We present a study describing epidemiological changes in severe TBI and the impact these changes have had on management and analysing alternatives that may improve outcomes in this new population.

MATERIALS AND METHODS

We performed a retrospective, descriptive, cross-sectional analysis of patients presenting severe TBI at our hospital in the period of 1992-1996 and 2009-2013. We analysed demographic data, including age, sex, mortality, aetiology, anticoagulation, treatment, and functional outcome.

RESULTS

We reviewed data from 220 patients. In the second cohort, there were 40% fewer patients, mean age was 12 years older, patients were more frequently receiving anticoagulation therapy, and the percentage of interventions was halved. Aetiology varied, with traffic accidents being the main cause in the first group, and accidental falls and being hit by cars in the second group. There were no intergroup differences for mortality or functional outcomes.

CONCLUSION

The age of patients admitted due to severe TBI has increased. As a result of this, the main cause of severe TBI in our population is accidental falls in elderly, anticoagulated patients. Despite the low-energy nature of trauma, patients in the second cohort presented a poorer baseline status, and were less frequently eligible for surgery, with no improvement in mortality or functional outcomes.

Traumatic brain injury in the new millennium: A new population and new management

INTRODUCTION

Traumatic brain injury (TBI) is one of the leading causes of death and disability globally. We present a study describing epidemiological changes in severe TBI and the impact these changes have had on management and analysing alternatives that may improve outcomes in this new population.

MATERIALS AND METHODS

We performed a retrospective, descriptive, cross-sectional analysis of patients presenting severe TBI at our hospital in the period of 1992-1996 and 2009-2013. We analysed demographic data, including age, sex, mortality, aetiology, anticoagulation, treatment, and functional outcome.

RESULTS

We reviewed data from 220 patients. In the second cohort, there were 40% fewer patients, mean age was 12years older, patients were more frequently receiving anticoagulation therapy, and the percentage of interventions was halved. Aetiology varied, with traffic accidents being the main cause in the first group, and accidental falls and being hit by cars in the second group. There were no intergroup differences for mortality or functional outcomes.

CONCLUSION

The age of patients admitted due to severe TBI has increased. As a result of this, the main cause of severe TBI in our population is accidental falls in elderly, anticoagulated patients. Despite the low-energy nature of trauma, patients in the second cohort presented a poorer baseline status, and were less frequently eligible for surgery, with no improvement in mortality or functional outcomes.

[The joint management of Geriatrics-Neurosurgery of patients older than 75 years reduces the average stay, morbidity, hospital readmissions and mortality per year]

OBJECTIVE

Population ageing is a reality for which national health systems are not adapted. The World Health Organisation has already raised awareness about the implementation of specific measures, from undergraduate training to dedicated elderly care units, to tackle this situation. In this article, the aim is to analyse the potential benefits of geriatric monitoring on elderly neurosurgical patients.

MATERIAL AND METHODS

A descriptive analysis was performed in this medical centre, comparing the information collected from elderly patients (over 75 years of age) admitted into the neurosurgical department during 2periods: June 2015 to February 2017, in which a shared geriatric monitoring was implemented, and between October 2013 and May 2015, equivalent period, in which only the geriatrician performed the evaluation of the patients' general condition, before referring them to other social-healthcare units. A number of factors were considered, including mean age, gender, the neurosurgical condition that led to admission, mean stay, infectious complications, acute confusional syndrome, admission into an intensive care unit, need for support from other medical departments, reoperations, mortality during hospitalisation, referral to social-health units, readmission within a month, and mortality within a year.

RESULTS

A total of 173 patients on shared monitoring were compared to 189 patients from the previous period. Both groups had similar demographic characteristics. During the analysis, a significant reduction was observed in shared monitoring as regards, mean hospitalisation, infectious complications, admissions into an intensive care unit, the need for support from other medical departments, readmissions within a month, and mortality within a year.

CONCLUSIONS

On patients of over 75 years of age, shared geriatric-neurosurgical monitoring reduces mean hospitalisation, morbidity, the need for support from other medical departments, early readmission, and mortality within a year. This strategy prioritises patient care, reduces costs, and rationalises resources.