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Ma Z, He Z, Li Z, Gong R, Hui J, Weng W, Wu X, Yang C, Jiang J, Xie L, Feng J. Traumatic brain injury in elderly population: A global systematic review and meta-analysis of in-hospital mortality and risk factors among 2.22 million individuals. Ageing Res Rev 2024; 99:102376. [PMID: 38972601 DOI: 10.1016/j.arr.2024.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) among elderly individuals poses a significant global health concern due to the increasing ageing population. METHODS We searched PubMed, Cochrane Library, and Embase from database inception to Feb 1, 2024. Studies performed in inpatient settings reporting in-hospital mortality of elderly people (≥60 years) with TBI and/or identifying risk factors predictive of such outcomes, were included. Data were extracted from published reports, in-hospital mortality as our main outcome was synthesized in the form of rates, and risk factors predicting in-hospital mortality was synthesized in the form of odds ratios. Subgroup analyses, meta-regression and dose-response meta-analysis were used in our analyses. FINDINGS We included 105 studies covering 2217,964 patients from 30 countries/regions. The overall in-hospital mortality of elderly patients with TBI was 16 % (95 % CI 15 %-17 %) from 70 studies. In-hospital mortality was 5 % (95 % CI, 3 %-7 %), 18 % (95 % CI, 12 %-24 %), 65 % (95 % CI, 59 %-70 %) for mild, moderate and severe subgroups from 10, 7, and 23 studies, respectively. A decrease in in-hospital mortality over years was observed in overall (1981-2022) and in severe (1986-2022) elderly patients with TBI. Older age 1.69 (95 % CI, 1.58-1.82, P < 0.001), male gender 1.34 (95 % CI, 1.25-1.42, P < 0.001), clinical conditions including traffic-related cause of injury 1.22 (95 % CI, 1.02-1.45, P = 0.029), GCS moderate (GCS 9-12 compared to GCS 13-15) 4.33 (95 % CI, 3.13-5.99, P < 0.001), GCS severe (GCS 3-8 compared to GCS 13-15) 23.09 (95 % CI, 13.80-38.63, P < 0.001), abnormal pupillary light reflex 3.22 (95 % CI, 2.09-4.96, P < 0.001), hypotension after injury 2.88 (95 % CI, 1.06-7.81, P = 0.038), polytrauma 2.31 (95 % CI, 2.03-2.62, P < 0.001), surgical intervention 2.21 (95 % CI, 1.22-4.01, P = 0.009), pre-injury health conditions including pre-injury comorbidity 1.52 (95 % CI, 1.24-1.86, P = 0.0020), and pre-injury anti-thrombotic therapy 1.51 (95 % CI, 1.23-1.84, P < 0.001) were related to higher in-hospital mortality in elderly patients with TBI. Subgroup analyses according to multiple types of anti-thrombotic drugs with at least two included studies showed that anticoagulant therapy 1.70 (95 % CI, 1.04-2.76, P = 0.032), Warfarin 2.26 (95 % CI, 2.05-2.51, P < 0.001), DOACs 1.99 (95 % CI, 1.43-2.76, P < 0.001) were related to elevated mortality. Dose-response meta-analysis of age found an odds ratio of 1.029 (95 % CI, 1.024-1.034, P < 0.001) for every 1-year increase in age on in-hospital mortality. CONCLUSIONS In the field of elderly patients with TBI, the overall in-hospital mortality and its temporal-spatial feature, the subgroup in-hospital mortalities according to injury severity, and dose-response meta-analysis of age were firstly comprehensively summarized. Substantial key risk factors, including the ones previously not elucidated, were identified. Our study is thus of help in underlining the importance of treating elderly TBI, providing useful information for healthcare providers, and initiating future management guidelines. This work underscores the necessity of integrating elderly TBI treatment and management into broader health strategies to address the challenges posed by the aging global population. REVIEW REGISTRATION PROSPERO CRD42022323231.
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Affiliation(s)
- Zixuan Ma
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Zhenghui He
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Zhifan Li
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Ru Gong
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jiyuan Hui
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Weiji Weng
- Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Xiang Wu
- Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Chun Yang
- Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Jiyao Jiang
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Li Xie
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Junfeng Feng
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Shanghai Institute of Head Trauma, Shanghai 200127, China.
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Sam JE, Komatsu F, Yamada Y, Tanaka R, Sasaki K, Tamura T, Kato Y. Endoscopic Evacuation of Acute Subdural Hematomas: A New Selection Criterion. Asian J Neurosurg 2024; 19:153-159. [PMID: 38974426 PMCID: PMC11226281 DOI: 10.1055/s-0044-1787101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Introduction Acute subdural hematomas (ASDHs) have a high mortality rate and unfavorable outcomes especially in the elderly population even after surgery is performed. The conventional recommended surgeries by the Brain Trauma Foundation in 2006 were craniotomies or craniectomies for ASDH. As the world population ages, and endoscopic techniques improve, endoscopic surgery should be utilized to improve the outcomes in elderly patients with ASDH. Materials and Methods This was a single-center retrospective report on our series of six patients that underwent endoscopic ASDH evacuation (EASE). Demographic data, the contralateral global cortical atrophy (GCA) score, evacuation rates, and outcomes were analyzed. Results All patients' symptoms and Glasgow Coma Scale improved or were similar after EASE with no complications. Good outcome was seen in 4 (66.7%) patients. Patients with poor outcome had initial low Glasgow Coma Scale scores on admission. The higher the contralateral GCA score, the higher the evacuation rate ( r = 0.825, p ≤ 0.043). All the patients had a GCA score of ≥7. Conclusion EASE is at least not inferior to craniotomy for the elderly population in terms of functional outcome for now. Using the contralateral GCA score may help identify suitable patients for this technique instead of just using a cut-off age as a criteria.
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Affiliation(s)
- Jo Ee Sam
- Department of Neurosurgery, Hospital Pulau Pinang, Penang, Malaysia
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Fuminari Komatsu
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Kento Sasaki
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Takamitsu Tamura
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
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Iderdar Y, Arraji M, Wachami NA, Guennouni M, Boumendil K, Mourajid Y, Elkhoudri N, Saad E, Chahboune M. Predictors of outcomes 3 to 12 months after traumatic brain injury: a systematic review and meta-analysis. Osong Public Health Res Perspect 2024; 15:3-17. [PMID: 38481046 PMCID: PMC10982655 DOI: 10.24171/j.phrp.2023.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 04/04/2024] Open
Abstract
The exact factors predicting outcomes following traumatic brain injury (TBI) remain elusive. In this systematic review and meta-analysis, we examined factors influencing outcomes in adult patients with TBI, from 3 months to 1 year after injury. A search of four electronic databases-PubMed, Scopus, Web of Science, and ScienceDirect-yielded 29 studies for review and 16 for meta-analysis, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. In patients with TBI of any severity, mean differences were observed in age (8.72 years; 95% confidence interval [CI], 4.77-12.66 years), lymphocyte count (-0.15 109/L; 95% CI, -0.18 to -0.11), glucose levels (1.20 mmol/L; 95% CI, 0.73-1.68), and haemoglobin levels (-0.91 g/dL; 95% CI, -1.49 to -0.33) between those with favourable and unfavourable outcomes. The prevalence rates of unfavourable outcomes were as follows: abnormal cisterns, 65.7%; intracranial pressure above 20 mmHg, 52.9%; midline shift of 5 mm or more, 63%; hypotension, 71%; hypoxia, 86.8%; blood transfusion, 70.3%; and mechanical ventilation, 90%. Several predictors were strongly associated with outcome. Specifically, age, lymphocyte count, glucose level, haemoglobin level, severity of TBI, pupillary reaction, and type of injury were identified as potential predictors of long-term outcomes.
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Affiliation(s)
- Younes Iderdar
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Maryem Arraji
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Nadia Al Wachami
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Morad Guennouni
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
- Science and Technology Team, Higher School of Education and Training, Chouaîb Doukkali University of El Jadida, El Jadida, Morocco
| | - Karima Boumendil
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Yassmine Mourajid
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Noureddine Elkhoudri
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Elmadani Saad
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Mohamed Chahboune
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
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Marrone F, Zavatto L, Allevi M, Di Vitantonio H, Millimaggi DF, Dehcordi SR, Ricci A, Taddei G. Management of Mild Brain Trauma in the Elderly: Literature Review. Asian J Neurosurg 2021; 15:809-820. [PMID: 33708648 PMCID: PMC7869288 DOI: 10.4103/ajns.ajns_205_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/14/2020] [Accepted: 07/03/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose The world population is aging. As direct consequence, geriatric trauma is increasing both in absolute number and in the proportion of annual admissions causing a challenge for the health-care system worldwide. The aim of this review is to delineate the specific and practice rules for the management of mild brain trauma in the elderly. Methods Systematic review of the last 15 years literature on mild traumatic brain injury (nTBI) in elderly patients. Results A total of 68 articles met all eligibility criteria and were selected for the systematic review. We collected 29% high-quality studies and 71% low-quality studies. Conclusion Clinical advices for a comprehensive management are provided. Current outcome data from mTBIs in the elderly show a condition that cannot be sustained in the future by families, society, and health-care systems. There is a strong need for more research on geriatric mild brain trauma addressed to prevent falls, to reduce the impact of polypharmacy, and to define specific management strategies.
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Affiliation(s)
- Federica Marrone
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Luca Zavatto
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Mario Allevi
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Hambra Di Vitantonio
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Soheila Raysi Dehcordi
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Graziano Taddei
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
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Ducos Y, Aghakhani N. Prognostic factors for unfavorable outcome after mild traumatic brain injury. A review of literature. Neurochirurgie 2020; 67:259-264. [PMID: 32593671 DOI: 10.1016/j.neuchi.2020.04.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/08/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unfavorable outcomes occur in 15-20% of patients with mild traumatic brain injury (mTBI). Early identification of patients at risk of unfavorable outcome is crucial for suitable management to be initiated, increasing the chances of full recovery. Many studies have been published on prognostic factors, but are not of a high level of evidence and certainty. A number of factors have been proposed and predictive models have been constructed that, although attractive, have not yet been externally validated. OBJECTIVES A review of literature (systematic search of PubMed and Google Scholar) assembled relevant available information about prognostic factors for unfavorable outcome after mTBI. We discuss the consistency of these findings, and the possibility and difficulty of using these factors in a daily practice. RESULTS It appears that the strongest and most consistent predictors are the number, severity and duration of symptoms present in the first few days after the trauma.
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Affiliation(s)
- Y Ducos
- Department of Neurosurgery, Paris, France
| | - N Aghakhani
- Department of Neurosurgery, Paris, France; Center for Evaluation and Multidisciplinary Care of Mild Traumatic Brain Injury, Bicêtre University Hospital, Paris, France.
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Herrmann LL, Deatrick JA. Experiences and Perceptions of Hospitalization and Recovery of Older Adults and Their Caregivers Following Traumatic Brain Injury: "Not Knowing". Res Gerontol Nurs 2019; 12:227-238. [PMID: 31283828 DOI: 10.3928/19404921-20190610-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/22/2019] [Indexed: 11/20/2022]
Abstract
The purpose of the current study is to describe the experience and perceptions of older adults and their caregivers following hospitalization for mild or moderate traumatic brain injury (TBI). Qualitative analysis of data obtained in individual semi-structured interviews with older adults and their caregivers (N = 11, five dyads and one individual) was performed to capture the perceptions and experiences of the survivor and their caregivers about the acute injury, hospitalization, and recovery. Data were collected over a 2-month period following discharge from the hospital. Open coding and constant comparative analysis generated codes that were revised throughout the analysis and reformulated into thematic descriptions. As a result, seven interrelated themes were identified. These findings can be used to implement interventions focused on recovery, communication, teaching, patient outcomes, and satisfaction. [Res Gerontol Nurs. 2019; 12(5):227-238].
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Prasad GL, Anmol N, Menon GR. Outcome of Traumatic Brain Injury in the Elderly Population: A Tertiary Center Experience in a Developing Country. World Neurosurg 2018; 111:e228-e234. [DOI: 10.1016/j.wneu.2017.12.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 12/11/2022]
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Neurosurgery in Octogenarians: A Prospective Study of Perioperative Morbidity, Mortality, and Complications in Elderly Patients. World Neurosurg 2018; 110:e287-e295. [DOI: 10.1016/j.wneu.2017.10.154] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/21/2022]
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9
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Julien J, Joubert S, Ferland MC, Frenette L, Boudreau-Duhaime M, Malo-Véronneau L, de Guise E. Association of traumatic brain injury and Alzheimer disease onset: A systematic review. Ann Phys Rehabil Med 2017; 60:347-356. [DOI: 10.1016/j.rehab.2017.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/13/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022]
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10
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Prasad GL. Outcome of Head Injury in the Elderly. World Neurosurg 2017; 103:944. [DOI: 10.1016/j.wneu.2017.02.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022]
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Julien J, Alsideiri G, Marcoux J, Hasen M, Correa JA, Feyz M, Maleki M, de Guise E. Antithrombotic agents intake prior to injury does not affect outcome after a traumatic brain injury in hospitalized elderly patients. J Clin Neurosci 2017; 38:122-125. [PMID: 28110930 DOI: 10.1016/j.jocn.2016.12.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study is to investigate the effect of risk factors including International Normalized Ratio (INR) as well as the Partial Thromboplastin Time (PTT) scores on several outcomes, including hospital length of stay (LOS) and The Extended Glasgow Outcome Scale (GOSE) following TBI in the elderly population. METHODS Data were retrospectively collected on patients (n=982) aged 65 and above who were admitted post TBI to the McGill University Health Centre-Montreal General Hospital from 2000 to 2011. Age, Injury Severity Score (ISS), Glasgow Coma Scale score (GCS), type of trauma (isolated TBI vs polytrauma including TBI), initial CT scan results according to the Marshall Classification and the INR and PTT scores and prescriptions of antiplatelet or anticoagulant agents (AP/AC) were collected. RESULTS Results also indicated that age, ISS and GSC score have an effect on the GOSE score. We also found that taking AC/AP has an effect on GOSE outcome, but that this effects depends on PTT, with lower odds of a worse outcome for those taking AC/AP agents as the PTT value goes up. However, this effect only becomes significant as the PTT value reaches 60 and above. CONCLUSION Age and injury severity rather than antithrombotic agent intake are associated with adverse acute outcome such as GOSE in hospitalized elderly TBI patients.
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Affiliation(s)
- Jessica Julien
- Department of Psychology, University of Montreal, Canada; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Canada
| | - Ghusn Alsideiri
- Montreal Neurological Institute & Hospital, McGill University, Canada
| | - Judith Marcoux
- Neurology and Neurosurgery Department, McGill University Health Centre, Canada
| | | | - José A Correa
- Department of Mathematics and Statistics, McGill University, Canada
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Centre, Canada
| | - Mohammed Maleki
- Neurology and Neurosurgery Department, McGill University Health Centre, Canada
| | - Elaine de Guise
- Department of Psychology, University of Montreal, Canada; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Canada; Research Institute-McGill University Health Center, Canada.
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Ziebell JM, Rowe RK, Muccigrosso MM, Reddaway JT, Adelson PD, Godbout JP, Lifshitz J. Aging with a traumatic brain injury: Could behavioral morbidities and endocrine symptoms be influenced by microglial priming? Brain Behav Immun 2017; 59:1-7. [PMID: 26975888 DOI: 10.1016/j.bbi.2016.03.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/01/2016] [Accepted: 03/11/2016] [Indexed: 12/20/2022] Open
Abstract
A myriad of factors influence the developmental and aging process and impact health and life span. Mounting evidence indicates that brain injury, even moderate injury, can lead to lifetime of physical and mental health symptoms. Therefore, the purpose of this mini-review is to discuss how recovery from traumatic brain injury (TBI) depends on age-at-injury and how aging with a TBI affects long-term recovery. TBI initiates pathophysiological processes that dismantle circuits in the brain. In response, reparative and restorative processes reorganize circuits to overcome the injury-induced damage. The extent of circuit dismantling and subsequent reorganization depends as much on the initial injury parameters as other contributing factors, such as genetics and age. Age-at-injury influences the way the brain is able to repair itself, as a result of developmental status, extent of cellular senescence, and injury-induced inflammation. Moreover, endocrine dysfunction can occur with TBI. Depending on the age of the individual at the time of injury, endocrine dysfunction may disrupt growth, puberty, influence social behaviors, and possibly alter the inflammatory response. In turn, activation of microglia, the brain's immune cells, after injury may continue to fuel endocrine dysfunction. With age, the immune system develops and microglia become primed to subsequent challenges. Sustained inflammation and microglial activation can continue for weeks to months post-injury. This prolonged inflammation can influence developmental processes, behavioral performance and age-related decline. Overall, brain injury may influence the aging process and expedite glial and neuronal alterations that impact mental health.
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Affiliation(s)
- Jenna M Ziebell
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia; Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.
| | - Rachel K Rowe
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; Neuroscience Graduate Program, Arizona State University, Tempe, AZ, USA
| | | | - Jack T Reddaway
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; University of Bath, Department of Biology and Biochemistry, Bath, United Kingdom
| | - P David Adelson
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; University of Bath, Department of Biology and Biochemistry, Bath, United Kingdom
| | - Jonathan P Godbout
- Department of Neuroscience, Ohio State University, Columbus, OH, USA; Center for Brain and Spinal Cord Repair, Ohio State University, Columbus, OH, USA; Institute for Behavioral Medicine Research, Ohio State University, Columbus, OH, USA
| | - Jonathan Lifshitz
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; Neuroscience Graduate Program, Arizona State University, Tempe, AZ, USA; VA Healthcare System, Phoenix, AZ, USA
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Prognostic Markers for Poor Recovery After Mild Traumatic Brain Injury in Older Adults: A Pilot Cohort Study. J Head Trauma Rehabil 2016; 31:E33-E43. [DOI: 10.1097/htr.0000000000000226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Head Injury in the Elderly: What Are the Outcomes of Neurosurgical Care? World Neurosurg 2016; 94:493-500. [DOI: 10.1016/j.wneu.2016.07.057] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 11/23/2022]
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Abstract
Traumatic brain injury (TBI) represents a wide spectrum of disease and disease severity. Because the primary brain injury occurs before the patient enters the health care system, medical interventions seek principally to prevent secondary injury. Anesthesia teams that provide care for patients with TBI both in and out of the operating room should be aware of the specific therapies and needs of this unique and complex patient population.
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Mercier E, Mitra B, Cameron PA. Challenges in assessment of the mild traumatic brain injured geriatric patient. Injury 2016; 47:985-7. [PMID: 27125183 DOI: 10.1016/j.injury.2016.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Eric Mercier
- School of Public Health and Preventive Medicine, Monash University, Australia; Emergency and Trauma Centre, The Alfred Hospital, Alfred Health, Australia; Department of General Family Medicine and Emergency Medicine, Laval University, Canada.
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Australia; Emergency and Trauma Centre, The Alfred Hospital, Alfred Health, Australia; National Trauma Research Institute, Melbourne, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Australia; Emergency and Trauma Centre, The Alfred Hospital, Alfred Health, Australia; National Trauma Research Institute, Melbourne, Australia
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Hosseini SH, Ayyasi M, Akbari H, Heidari Gorji MA. Comparison of Glasgow Coma Scale, Full Outline of Unresponsiveness and Acute Physiology and Chronic Health Evaluation in Prediction of Mortality Rate Among Patients With Traumatic Brain Injury Admitted to Intensive Care Unit. Anesth Pain Med 2016; 7:e33653. [PMID: 29696116 PMCID: PMC5903254 DOI: 10.5812/aapm.33653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/05/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a common cause of mortality and disability worldwide. Choosing an appropriate diagnostic tool is critical in early stage for appropriate decision about primary diagnosis, medical care and prognosis. Objectives This study aimed to compare the Glasgow coma scale (GCS), full outline of unresponsiveness (FOUR) and acute physiology and chronic health evaluation (APACHE II) with respect to prediction of the mortality rate of patients with TBI admitted to intensive care unit. Patients and Methods This diagnostic study was conducted on 80 patients with TBI in educational hospitals. The scores of APACHE II, GCS and FOUR were recorded during the first 24 hours of admission of patients. In this study, early mortality means the patient death before 14 days and delayed mortality means the patient death 15 days after admitting to hospital. The collected data were analyzed using descriptive and inductive statistics. Results The results showed that the mean age of the patients was 33.80 ± 12.60. From a total of 80 patients with TBI, 16 (20%) were females and 64 (80%) males. The mortality rate was 15 (18.7%). The results showed no significant difference among three tools. In prediction of early mortality, the areas under the curve (AUCs) were 0.92 (CI = 0.95. 0.81 - 0.97), 0.90 (CI = 0.95. 0.74 - 0.94), and 0.96 (CI = 0.95. 0.87 - 0.9) for FOUR, APACHE II and GCS, respectively. In delayed mortality, the AUCs were 0.89 (CI = 0.95. 0.81-0.94), 0.94 (CI = 0.95. 0.74 - 0.97) and 0.90 (CI = 0.95. 0.87 - 0.95) for FOUR, APACHE II and GCS, respectively. Conclusions Considering that GCS is easy to use and the FOUR can diagnose a locking syndrome along same values of subscales. These two subscales are superior to APACHI II in prediction of early mortality. Conversation APACHE II is more punctual in the prediction of delayed mortality.
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Affiliation(s)
- Seyed Hossein Hosseini
- Department of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mitra Ayyasi
- Department of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hooshang Akbari
- Department of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Ali Heidari Gorji
- Department of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
- Corresponding author: Mohammad Ali Heidari Gorji, Department of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran. Tel: +98-9216298273, E-mail:
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de Guise E, Bélanger S, Tinawi S, Anderson K, LeBlanc J, Lamoureux J, Audrit H, Feyz M. Usefulness of the rivermead postconcussion symptoms questionnaire and the trail-making test for outcome prediction in patients with mild traumatic brain injury. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:213-22. [DOI: 10.1080/23279095.2015.1038747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Elaine de Guise
- Psychology Department, University of Montreal, Montreal, Quebec, Canada
- Neurology and Neurosurgery Department, McGill University, Montreal, Quebec, Canada
| | - Sara Bélanger
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Montreal, Quebec, Canada
| | - Simon Tinawi
- Rehabilitation Medicine Department, McGill University Health Centre-Montreal General Hospital, Montreal, Quebec, Canada
| | - Kirsten Anderson
- Psychology Department, University of Montreal, Montreal, Quebec, Canada
| | - Joanne LeBlanc
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Montreal, Quebec, Canada
| | - Julie Lamoureux
- Social and Preventive Medicine Department, University of Montreal, Montreal, Quebec, Canada
| | - Hélène Audrit
- Psychology Department, University of Montreal, Montreal, Quebec, Canada
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Montreal, Quebec, Canada
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Whitehouse KJ, Jeyaretna DS, Wright A, Whitfield PC. Neurosurgical Care in the Elderly: Increasing Demands Necessitate Future Healthcare Planning. World Neurosurg 2015; 87:446-54. [PMID: 26585726 DOI: 10.1016/j.wneu.2015.10.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The worldwide elderly population is steadily increasing. It has been recommended that age-appropriate information should be available for older patients, but little exists in neurosurgery. We aim to better understand the clinical characteristics, bed occupancy and outcomes of elderly patients admitted to a UK neurosurgical unit. METHODS Retrospective review of medical records of all patients aged 75 years and older admitted for at least 1 night to the Southwest Neurosurgery Centre from 2007 to 2010. Mortality data up to 31 December 2012 were obtained from a national registry. RESULTS Eight hundred and eighty-six elderly patients were admitted, for whom 877 records were available. Three hundred and eighty-nine patients were admitted electively; 488 were emergency or urgent; 48.8% had cranial pathology and 50.7% had spinal disease. Emergency cases were significantly older and more likely to be male than elective patients. The median length of stay for emergency patients was significantly longer than that of elective patients (P < 0.0001, 3 vs. 8 days). One elective patient died as an inpatient, compared with 46 emergency patients. Of emergency and elective patients, 25.6% and 3.6%, respectively, had died by 6 months after discharge. Age and length of stay were not associated with early death. CONCLUSIONS The demographics and outcomes of the elderly admitted to a UK neurosurgical center are discussed. Differences between elective and emergency groups are attributable to both the pathologic processes and case selection. Neurosurgical treatment should not be denied based on age, however the high risks of emergency surgery in this age group should be acknowledged.
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Affiliation(s)
| | - Deva Sanjeeva Jeyaretna
- Department of Neurosurgery and Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Alan Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Peter C Whitfield
- South West Neurosurgery Centre, Plymouth Hospitals NHS Trust, Plymouth, UK
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Gorji MAH, Gorji AMH, Hosseini SH. Which score should be used in intubated patients' Glasgow coma scale or full outline of unresponsiveness? Int J Appl Basic Med Res 2015; 5:92-5. [PMID: 26097814 PMCID: PMC4456901 DOI: 10.4103/2229-516x.157152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/27/2015] [Indexed: 11/22/2022] Open
Abstract
Background and Aims: Today Glasgow coma scale (GCS) is the most well-known and common score for evaluation of the level of consciousness and outcome predict after traumatic brain injuries in the world. Regarding to some advantages of the full outline of unresponsiveness (FOUR) score over GCS in intubated patients, we’re going to compare the precision of these two scores in predicting the outcome predict in intubated patients. Methods: This research was a diagnostic-based study, which was conducted prospectively on 80 patients with Traumatic brain injury who were intubated and admitted to Intensive Care Unit (ICU) of Educational Hospitals of Mazandaran University of Medical Science during February 2013 to August 2013. The scores of FOUR and GCS were measured by the researcher in the first 24 h of admission in ICU. The information's recorded in the check list including the mortality rate of early and late inside of the hospital interred to excel. The findings were analyzed using SPSS software, through descriptive statistics and regression logistic. Results: The results showed of 80 patients 21 patients (20%) were female and 59 patients (80%) were male. The age average of the samples was 33.80 ± 12.60 ranging from 16 to 60 years old. 21 patients (26.2%) died during treatment. Of 21 patients, 15 patients died during first 14 days (18.7%) and 6 patients died after 14 years (7.5%). The area under curve (AUC) of FOUR score in early mortality was 0.90 (C1 = 0.95, 0.88–0.90). The amount AUC for GCS was 0.80 (C1 = 0.95, 0.78–0.84), which in delayed mortality it was ordered as 0.86 (C1 = 0.95, 0.84–0.90) and 0.89 (C1 = 0.95, 0.78–0.88). Conclusion: The research results indicated that FOUR score is more exact and more practical in intubated patients regarding lack of verbal response factor in early mortality prediction in GCS. Hence, it is recommended for health professionals to use the FOUR score to predict the early outcome of intubated patients with traumatic brain injuries.
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Affiliation(s)
| | | | - Seyed Hossein Hosseini
- Department of Nursing and Midwiferi Nasibeh, Mazandaran University of Medical Sciences, Sari, Iran
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de Guise E, LeBlanc J, Dagher J, Tinawi S, Lamoureux J, Marcoux J, Maleki M, Feyz M. Traumatic brain injury in the elderly: A level 1 trauma centre study. Brain Inj 2015; 29:558-64. [PMID: 25625679 DOI: 10.3109/02699052.2014.976593] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore the characteristics and outcome of patients with TBI over 65 years old admitted to an acute care Level 1 Trauma centre in Montreal, Canada. METHODS Data were retrospectively collected on patients (n = 1812) who were admitted post-TBI to the McGill University Health Centre-Montreal General Hospital from 2000-2011. The cohort was composed of four groups over 65 years old (65-75; 76-85; 86-95; and 96 and more). Outcome measures used were the extended Glasgow Outcome Scale (GOSE) as well as discharge destination. RESULTS As the patients got older, the odds of having a poor outcome increased (OR = 2.344 for those 75-85 years old, 4.313 for those 86-95 years of age and 3.465 for those aged 96 years of age or older). Also, the proportion of patients going home or going home with out-patient rehabilitation decreased as age increased (p = 0.001 and p < 0.001, respectively). In contrast, the proportion of patients being discharged to long-term care facilities increased significantly as age increased (p < 0.001). CONCLUSION This descriptive study provides a better understanding of characteristics and outcome of different age groups of patients with TBI all over 65 years old in Montreal, Canada.
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Affiliation(s)
- Elaine de Guise
- Neurology and Neurosurgery Department, McGill University Health Centre , Montreal, Quebec , Canada
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Gorji MAH, Hoseini SH, Gholipur A, Mohammadpur RA. A comparison of the diagnostic power of the Full Outline of Unresponsiveness scale and the Glasgow coma scale in the discharge outcome prediction of patients with traumatic brain injury admitted to the intensive care unit. Saudi J Anaesth 2014; 8:193-7. [PMID: 24843331 PMCID: PMC4024675 DOI: 10.4103/1658-354x.130708] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and Aim: This study aimed to determine whether the Full Outline of Unresponsiveness (FOUR) score is an accurate predictorof discharge outcome in traumatic brain injury (TBI) patients and to compare its performanceto Glasgow coma scale (GCS). Materials and Methods: Thisis diagnostic study conducted prospectively on 53 TBI patients admitted to ICU of education hospitals of Medical Science University of Mazandaran during February 2013 to June 2013. Data collection was done with a checklist including biographic, clinical information and outcome. The FOUR score and GCS were determined by the researcher in the first 24 hours. Outcomes considered as in-hospital mortality and poor neurologic outcome (Glasgow Outcome Scale (GOS) 1-3) in discharge time from the hospital. Results: In terms of predictive power for in-hospital mortality, the area under the receiver operating characteristic (ROC) curve was 0/92 (95% CI. 0/81-0/97) for FOUR score and 0/96 (95% CI. 0/87-0/99) for GCS. In terms of predictive power of poor neurologic outcome, the area under the ROC curve was 0/95 (95% CI. 0/86-0/99) for FOUR score and 0/90 (95% CI.0/79-0/96) for GCS as evidenced by GOS 1-3. The cut-off of 6 showed sensitivity and specificity of total four score predicting poor outcome at 0/86 and 0/87 while the cut-off of 4 showed the value of in hospital mortality at 0/90 and 0/90. The total GCS score showed sensitivity and specificity 0/100 and 0/61 at cut-off 7 in predicting poor outcome while in predicting mortality at cut-off of 4 this range was 0/100 and 0/92. Conclusion: The FOUR score is an accurate predictor of discharge outcome in TBI patients. Thus, researchers recommend for therapeutic Schematizationto use in neurosurgical patients at admission day.
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Affiliation(s)
| | - Seyed Hosein Hoseini
- Department of Nursing Surgery, Mazandaran University of Medical Science, Sari, Iran
| | - Afshin Gholipur
- Department of Nursing Medicine, Mazandaran University of Medical Science, Sari, Iran
| | - Reza Ali Mohammadpur
- Department of Nursing Surgery, Mazandaran University of Medical Science, Sari, Iran
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Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer? J Trauma Acute Care Surg 2014; 76:196-200. [PMID: 24368379 DOI: 10.1097/ta.0b013e3182a833ac] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The frailty index (FI) has been shown to predict outcomes in geriatric patients. However, FI has never been applied as a prognostic measure after trauma. The aim of our study was to identify hospital admission factors predicting discharge disposition in geriatric trauma patients. METHODS We performed a 1-year prospective study at our Level 1 trauma center. All trauma patients 65 years or older were enrolled. FI was calculated using 50 preadmission variables. Patient's discharge disposition was dichotomized as favorable outcome (discharge home, rehabilitation) or unfavorable outcomes (discharge to skilled nursing facility, death). Multivariate logistic regression was performed to identify factors that predict unfavorable outcome. RESULTS A total of 100 patients were enrolled, with a mean (SD) age of 76.51 (8.5) years, 59% being males, median Injury Severity Score (ISS) of 14 (range, 9-18), median head Abbreviated Injury Scale (h-AIS) score of 2 (2-3), and median Glasgow Coma Scale (GCS) score of 13 (12-15). Of the patients, 69% had favorable outcome, and 31% had unfavorable outcome. On univariate analysis, FI was found to be a significant predictor for unfavorable outcome (odds ratio, 1.8; 95% confidence interval, 1.2-2.3). After adjusting for age, ISS, and GCS score in a multivariate regression model, FI remained a strong predictor for unfavorable discharge disposition (odds ratio, 1.3; 95% confidence interval, 1.1-1.8). CONCLUSION The concept of frailty can be implemented in geriatric trauma patients with similar results as those of nontrauma and nonsurgical patients. FI is a significant predictor of unfavorable discharge disposition and should be an integral part of the assessment tools to determine discharge disposition for geriatric trauma patients. LEVEL OF EVIDENCE Prognostic study, level II.
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de Guise E, LeBlanc J, Champoux MC, Couturier C, Alturki AY, Lamoureux J, Desjardins M, Marcoux J, Maleki M, Feyz M. The mini-mental state examination and the montreal cognitive assessment after traumatic brain injury: An early predictive study. Brain Inj 2013; 27:1428-34. [DOI: 10.3109/02699052.2013.835867] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kirkman MA, Jenks T, Bouamra O, Edwards A, Yates D, Wilson MH. Increased Mortality Associated with Cerebral Contusions following Trauma in the Elderly: Bad Patients or Bad Management? J Neurotrauma 2013; 30:1385-90. [DOI: 10.1089/neu.2013.2881] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew A. Kirkman
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Tom Jenks
- Trauma Audit and Research Network, The University of Manchester, United Kingdom
| | - Omar Bouamra
- Trauma Audit and Research Network, The University of Manchester, United Kingdom
| | - Antoinette Edwards
- Trauma Audit and Research Network, The University of Manchester, United Kingdom
| | - David Yates
- Trauma Audit and Research Network, The University of Manchester, United Kingdom
| | - Mark H. Wilson
- The Traumatic Brain Injury Centre, Imperial College, St Mary's Hospital, London, United Kingdom
- London's Air Ambulance, Queen Mary University, The Royal London Hospital, London, United Kingdom
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Joseph B, Pandit V, Aziz H, Tang A, Kulvatunyou N, Wynne J, Hsu P, O'Keeffe T, Gries L, Friese RS, Rhee P. Rehabilitation after trauma; does age matter? J Surg Res 2013; 184:541-5. [PMID: 23664534 DOI: 10.1016/j.jss.2013.03.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/14/2013] [Accepted: 03/20/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Variability exits in the ability to predict overall recovery after trauma and inpatient rehabilitation. The aim of this study was to identify factors predicting functional improvement in trauma patients undergoing inpatient rehabilitation. METHODS We performed a 3-y retrospective cohort analysis on a prospectively collected database of all trauma patients discharged from a level I trauma center to a single inpatient rehabilitation center. Patient's Functional Independence Measures (FIM) scores on hospital discharge and on discharge from the rehabilitation center were collected. Delta FIM was defined as the difference in FIM between rehabilitation center discharge and hospital discharge. Multiple linear regressions were performed to identify hospital admission factors associated with delta FIM. RESULTS We included 160 patients, 69% were male, mean age 54.6 ± 22 y, and median Injury Severity Score 14 [10-50]. Based on rehabilitation admission FIM scores, 29 were totally dependent and 131 were partially dependent. The mean change in FIM was 39.4 ± 13. Age, gender, Glasgow Coma Scale on presentation, Injury Severity Score, systolic blood pressure on presentation, and intensive care unit length of stay were not predictive of delta FIM. Hospital length of stay and head Abbreviated Injury Score on hospital admission were negative predictors of delta FIM. CONCLUSIONS In our study, age as an independent factor was not predictive of functional outcome after injury. The extent of head injury continues to negatively affect the overall functional improvement based on FIM.
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Affiliation(s)
- Bellal Joseph
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona 85727, USA.
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McIntyre A, Mehta S, Aubut J, Dijkers M, Teasell RW. Mortality among older adults after a traumatic brain injury: a meta-analysis. Brain Inj 2012; 27:31-40. [PMID: 23163240 DOI: 10.3109/02699052.2012.700086] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To examine mortality rates among older adults (≥60 years) post-traumatic brain injury (TBI). RESEARCH DESIGN Systematic review and meta-analysis. METHODS AND PROCEDURES Using multiple databases, a literature search was conducted for articles on mortality after TBI published up to July 2011. Information on patient characteristics (age, Glasgow Coma Scale (GCS), injury aetiology, etc.), mortality rates, time to death and study design was extracted and pooled. MAIN OUTCOMES AND RESULTS Twenty-four studies had an overall mortality rate of 38.3% (CI 27.1-50.9%). The odds of mortality for those over 75 years compared to those of 65-74 years was 1.734 (CI = 1.311-2.292; p < 0.0001). Pooled mortality rates for mild (GCS 13-15), moderate (GCS 9-12) and severe (GCS 3-8) head injuries were 12.3% (CI = 6.1-23.3%), 34.3% (CI = 19.5-53.0%) and 65.3% (CI = 53.1-75.9), respectively. Odds ratios comparing severe to mild and moderate to mild head injuries were 12.69 (CI = 5.29-30.45; p < 0.0001) and 5.31 (CI = 3.41-8.29; p < 0.0001), respectively. There was no significant difference in the odds of death between severe and moderate injuries (p = 0.116). CONCLUSIONS These mortality rates associated with moderate and severe injuries may be attributed to complications, chronic disease prevalence, conservative management techniques or the consequences of biological ageing.
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Affiliation(s)
- Amanda McIntyre
- Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, ON, Canada
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Abstract
Mild traumatic brain injury (TBI) is an unfortunately common occurrence in the elderly. With the growing population of older adults in the United States and globally, strategies that reduce the risk of becoming injured need to be developed, and diagnostic tools and treatments that may benefit this group need to be explored. Particular attention needs to be given to polypharmacy, drug interactions, the use of anticoagulants, safety issues in the living environment, elder abuse, and alcohol consumption. Low-mechanism falls should prompt health care providers to consider the possibility of head injury in elderly patients. Early and tailored management of our seniors following a mild TBI can provide them with the best possible quality of life. This review will discuss the current literature on mild TBI in the older adult, address gaps in research, and discuss the implications for future care of the older TBI patient.
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OH HS, SEO WS. Development of a Decision Tree Analysis model that predicts recovery from acute brain injury. Jpn J Nurs Sci 2012; 10:89-97. [DOI: 10.1111/j.1742-7924.2012.00215.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Borkar SA, Sinha S, Agrawal D, Satyarthee GD, Gupta D, Mahapatra AK. Severe head injury in the elderly: risk factor assessment and outcome analysis in a series of 100 consecutive patients at a Level 1 trauma centre. INDIAN JOURNAL OF NEUROTRAUMA 2011. [DOI: 10.1016/s0973-0508(11)80004-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sogut O, Guloglu C, Orak M, Sayhan MB, Gokdemir MT, Ustundag M, Akkus Z. Trauma scores and neuron-specific enolase, cytokine and C-reactive protein levels as predictors of mortality in patients with blunt head trauma. J Int Med Res 2011; 38:1708-20. [PMID: 21309485 DOI: 10.1177/147323001003800516] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study evaluated serum neuron-specific enolase (NSE), cytokine and high-sensitivity C-reactive-protein (hs-CRP) levels, along with the Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS), as predictors of mortality in the early posttraumatic period, in 100 Turkish patients with blunt head trauma. Overall patient mortality was 27%. There was a significant association between age and mortality, and mortality was negatively correlated with GCS and RTS. Head injury severity (GCS) was significantly related to NSE, hs-CRP, interleukin (IL)-6, IL-8 and tumour necrosis factor (TNF)-alpha levels. Mortality correlated positively with IL-6, IL-8, TNF-alpha and hs-CRP levels. NSE, hs-CRP, IL-6, IL-8 and TNF-alpha levels were significantly higher in non-survivors compared with survivors. GCS score < or =8, younger age and NSE levels were significant independent predictors of mortality. During the early post-traumatic period, NSE may be an objective alternative criterion to the GCS, in the management of patients with blunt head trauma.
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Affiliation(s)
- O Sogut
- Department of Emergency Medicine, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
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Dagher JH, Habra N, Lamoureux J, De Guise E, Feyz M. Global outcome in acute phase of treatment following moderate-to-severe traumatic brain injury from motor vehicle collisions vs assaults. Brain Inj 2011; 24:1389-98. [PMID: 20887096 DOI: 10.3109/02699052.2010.523042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To compare socio-demographic, medical characteristics and acute outcomes between patients with traumatic brain injuries (TBIs) from motor vehicle collision (MVC) or assault in an acute care setting. RESEARCH DESIGN This descriptive, comparative retrospective cohort study included 415 patients with moderate and severe TBI secondary to an assault (n¼91) vs a motor vehicle collision (n=324). METHODS AND PROCEDURES Outcome measures were length of stay (LOS) in the intensive care unit and in hospital, Extended Glasgow Outcome Scale (GOS-E), FIM® instrument (‘FIM’) and discharge destination. MAIN OUTCOMES AND RESULTS Patients with TBI from MVC had a higher percentage of polytrauma, higher injury severity scores, required more orthopaedic surgeries and thoracic drain insertions. Patients with TBI from assault were more often non-Caucasian, young single men, less educated with higher unemployment rates and criminal records, with a history of alcohol and drug abuse and were more often intoxicated on admission. There was no significant group difference in the LOS and FIM ratings, but patients with assault-related TBI were more often discharged home and had a more favourable GOS-E. CONCLUSION Variables such as injury severity, age, level of intoxication on admission and presence of surgeries should be considered when determining acute outcome.
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Affiliation(s)
- Jehane H Dagher
- Physical Medicine and Rehabilitation Department, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
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Vadhanan S, Bhatoe HS. Understanding head injury: A prelude? INDIAN JOURNAL OF NEUROTRAUMA 2010. [DOI: 10.1016/s0973-0508(10)80023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chan LYL, Moran JL, Clarke C, Martin J, Solomon PJ. Mortality and cost outcomes of elderly trauma patients admitted to intensive care and the general wards of an Australian tertiary referral hospital. Anaesth Intensive Care 2010; 37:773-83. [PMID: 19775042 DOI: 10.1177/0310057x0903700511] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mortality and cost outcomes of elderly intensive care unit (ICU) trauma patients were characterised in a retrospective cohort study from an Australian tertiary ICU Trauma patients admitted between January 2000 and December 2005 were grouped into three major age categories: aged > or =65 years admitted into ICU (n = 272); aged -65 years admitted into general ward (n = 610) and aged < 65 years admitted into ICU (n = 1617). Hospital mortality predictors were characterised as odds ratios (OR) using logistic regression. The impact of predictor variables on (log) total hospital-stay costs was determined using least squares regression. An alternate treatment-effects regression model estimated the mortality cost-effect as an endogenous variable. Mortality predictors (P < or = 0.0001, comparator: ICU > or = 65 years, ventilated) were: ICU < 65 not-ventilated (OR 0.014); ICU < 65 ventilated (OR 0.090); ICU age > or = 65 not-ventilated (OR 0.061) and ward > or = 65 (OR 0.086); increasing injury severity score and increased Charlson comorbidity index of 1 and 2, compared with zero (OR 2.21 [1.40 to 3.48] and OR 2.57 [1.45 to 4.55]). The raw mean daily ICU and hospital costs in A$ 2005 (US$) for age < 65 and > or = 65 to ICU, and > or = 65 to the ward were; for year 2000: ICU, $2717 (1462) and $2777 (1494); hospital, $1837 (988) and $1590 (855); ward $933 (502); for year 2005: ICU, $3202 (2393) and $3086 (2307); hospital, $1938 (1449) and $1914 (1431); ward $1180 (882). Cost increments were predicted by age < or = 65 and ICU admission, increasing injury severity score, mechanical ventilation, Charlson comorbidity index increments and hospital survival. Mortality cost-effect was estimated at -63% by least squares regression and -82% by treatment-effects regression model. Patient demographic factors, injury severity and its consequences predict both cost and survival in trauma. The cost mortality effect was biased upwards by conventional least squares regression estimation.
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Affiliation(s)
- L Y L Chan
- Department of Intensive Care Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Oh H, Seo W. Functional and cognitive recovery of patients with traumatic brain injury: prediction tree model versus general model. Crit Care Nurse 2009; 29:12-22; quiz following 22. [PMID: 19648595 DOI: 10.4037/ccn2009279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- HyunSoo Oh
- Department of Nursing, College of Medicine, Inha University, Incheon, Republic of Korea
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de Guise E, Leblanc J, Feyz M, Lamoureux J. Prediction of the level of cognitive functional independence in acute care following traumatic brain injury. Brain Inj 2009; 19:1087-93. [PMID: 16286322 DOI: 10.1080/02699050500149882] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PRIMARY OBJECTIVE To determine a predictive model for cognitive functional outcome of patients with traumatic brain injury (TBI) at discharge from acute care. METHODS AND PROCEDURE Three hundred and thirty-five patients were included in this analysis. Variables considered were age, education, initial score on the Glasgow Coma Scale (GCS), duration of post-traumatic amnesia (PTA), cerebral imaging results and the need for neurosurgical intervention. EXPERIMENTAL INTERVENTIONS Functional Independence Measure (FIM). MAIN OUTCOMES AND RESULTS Results of this analysis indicated better cognitive FIM at discharge from acute care settings for patients with TBI when PTA was less than 24 hours, when level of education was higher, when no parietal lesion was identified, when no neurosurgical intervention was required, for patients with TBI who were younger and who presented with a higher GCS score upon admission. CONCLUSIONS This model will help to plan resource allocation for treatment and discharge planning within the first weeks following TBI.
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Affiliation(s)
- E de Guise
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Québec, Canada.
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Whyte J, Gosseries O, Chervoneva I, DiPasquale MC, Giacino J, Kalmar K, Katz DI, Novak P, Long D, Childs N, Mercer W, Maurer P, Eifert B. Predictors of short-term outcome in brain-injured patients with disorders of consciousness. PROGRESS IN BRAIN RESEARCH 2009; 177:63-72. [PMID: 19818895 DOI: 10.1016/s0079-6123(09)17706-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate predictors of recovery from the vegetative state (VS) and minimally conscious state (MCS) after brain injury as measured by the widely used Disability Rating Scale (DRS) and to explore differences in rate of recovery and predictors of recovery during inpatient rehabilitation in patients with non-traumatic (NTBI) and traumatic brain injury (TBI). DESIGN Longitudinal observational cohort design and retrospective comparison study, in which an initial DRS score was collected at the time of study enrollment. Weekly DRS scores were recorded until discharge from the rehabilitation center for both NTBI and TBI patients. SETTING Seven acute inpatient rehabilitation facilities in the United States and Europe with specialized programs for VS and MCS patients (the Consciousness Consortium). PARTICIPANTS One hundred sixty-nine patients with a non-traumatic (N=50) and a traumatic (N=119) brain injury who were in the VS or MCS states. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES DRS score at 13 weeks after injury; change in DRS score over 6 weeks post-admission; and time until commands were first followed (for patients who did not show command-following at or within 2 weeks of admission). RESULTS Both time between injury and enrollment and DRS score at enrollment were significant predictors of DRS score at week 13 post-injury but the main effect of etiology only approached significance. Etiology was however a significant predictor of the amount of recovery observed over the 6 weeks following enrollment. Time between injury and enrollment was also a good predictor of this outcome, but not DRS score at enrollment. For the time until commands were first followed, patients with better DRS scores at enrollment, and those with faster early rates of change recovered command following sooner than those with worse DRS scores or slower initial rates of change. The etiology was not a significant predictor for this last outcome. None of these predictive models explained sufficient variance to allow their use in individual clinical decision making. CONCLUSIONS Time post-injury and DRS score at enrollment are predictors of early recovery among patients with disorders of consciousness, depending on the outcome measure chosen. Etiology was also a significant predictor in some analyses, with traumatically injured patients recovering more than those with non-traumatic injuries. However, the hypothesized interaction between etiology and time post-injury did not reach significance in any of the analyses suggesting that, within the time frame studied, the decline in prognosis with the passage of time was similar in the two groups.
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Affiliation(s)
- J Whyte
- Moss Rehabilitation Research Institute/Albert Einstein Healthcare Network, Philadelphia, PA, USA.
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LeBlanc J, de Guise E, Gosselin N, Feyz M. Comparison of functional outcome following acute care in young, middle-aged and elderly patients with traumatic brain injury. Brain Inj 2007; 20:779-90. [PMID: 17060145 DOI: 10.1080/02699050600831835] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVE To compare functional physical and cognitive outcome of patients in three age groups with mild, moderate and severe traumatic brain injury (TBI) at discharge from acute care. RESEARCH DESIGN Retrospective database review. METHODS AND PROCEDURES Scores on the Extended Glasgow Outcome Scale (GOSE) and on the FIM instrument,1 discharge destination and length-of-stay (LOS) were gathered and compared for 2327 patients with TBI admitted to a level 1 trauma hospital from 1997-2003 divided into three age groups; 971 patients between 18-39 years, 672 between 40-59 years and 684 aged 60-99 years. MAIN OUTCOMES AND RESULTS Relative to younger adults with similar TBI severity, elderly patients showed worse outcome on the GOSE and FIM instrument (physical and cognitive ratings) and longer LOS. No difference was observed between the young and middle-aged groups except for cognitive FIM ratings and LOS for severe TBI. A higher percentage of elderly patients went to in-patient rehabilitation, to long-term care facilities or died compared to young and middle-aged patients. A higher number of young and middle-aged patients were discharged home. CONCLUSIONS Further development of services in early rehabilitation as well as post-rehabilitation geared to the specific needs of the elderly patient with TBI is required as the population ages.
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Affiliation(s)
- Joanne LeBlanc
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Montreal, Québec, Canada.
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de Guise E, LeBlanc J, Feyz M, Lamoureux J. Prediction of Outcome at Discharge From Acute Care Following Traumatic Brain Injury. J Head Trauma Rehabil 2006; 21:527-36. [PMID: 17122683 DOI: 10.1097/00001199-200611000-00007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compute outcome probabilities for persons with traumatic brain injury at discharge from acute care. PARTICIPANTS Three hundred thirty-nine patients with traumatic brain injury (239 mild, 48 moderate, 52 severe). SETTING Level I trauma center. MAIN MEASURES Predictor variables considered were age, education, Glasgow Coma Scale score, duration of posttraumatic amnesia, cerebral imaging results, and need for neurosurgical intervention. Outcome measures were Extended Glasgow Outcome Scale and discharge destination. RESULTS Logistic regressions showed that a shorter posttraumatic amnesia decreased the probability of moderate to severe disability. Moreover, discharge home was less probable for patients with positive cerebral imaging. CONCLUSION This model can help predict rehabilitation needs upon discharge from an acute care hospital.
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Affiliation(s)
- Elaine de Guise
- McGill University Health Centre - Montreal General, Montreal, Quebec, Canada.
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Flanagan SR, Hibbard MR, Riordan B, Gordon WA. Traumatic brain injury in the elderly: diagnostic and treatment challenges. Clin Geriatr Med 2006; 22:449-68; x. [PMID: 16627088 DOI: 10.1016/j.cger.2005.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this review is to introduce geriatric practitioners to issues and challenges presented in the elderly after onset of traumatic brain injury (TBI). Issues discussed include the magnitude of TBI in the elderly, mechanisms of onset, issues specific to both acute and rehabilitation care for the elderly with TBI, and specific physical and behavioral manifestations of TBI that may need to be addressed on an inpatient or outpatient basis. General guidelines are provided for the diagnosis and treatment of older individuals who have TBI, with specific clinical scenarios illustrating key points.
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Affiliation(s)
- Steven R Flanagan
- Rehabilitation Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1240, New York, NY 10029, USA.
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Crossley M, Shiel A, Wilson B, Coleman MR, Gelling L, Fryer T, Boniface S, Pickard J. Monitoring emergence from coma following severe brain injury in an octogenarian using behavioural indicators, electrophysiological measures and metabolic studies: a demonstration of the potential for good recovery in older adults. Brain Inj 2005; 19:729-37. [PMID: 16195187 DOI: 10.1080/02699050400013733] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This case study describes a multi-disciplinary investigation of the emergence from coma of an 80-year old female (KE) following severe traumatic brain injury. The relationship between cognitive/behavioural ability and the integrity of cerebral function was assessed using neuropsychological measures, positron emission tomography, electroencephalography, somatosensory evoked potentials and trans-cranial magnetic stimulation. These investigations were performed as KE was beginning to emerge from coma (4 weeks) and, again, approximately 1 year following brain injury, when she was judged to have achieved her maximum level of recovery. Neuropsychological measures revealed improvement during the first year post-injury in KE's speed of information processing, memory and executive abilities. Electrophysiological and metabolic studies indicated a restoration of functional integrity that was consistent with the gradual recovery in higher brain function documented using behavioural procedures. This case study demonstrates the rehabilitation potential of pre-morbidly healthy older adults following severe traumatic brain injury.
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Affiliation(s)
- M Crossley
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Abstract
Older individuals with TBI differ from younger adults with TBI in several ways, including their incidence rates, etiology of injury, nature of complications, lengths of hospitalization, functional outcomes, and mortality. Despite the greater likelihood of poorer functional outcomes, older adults with TBI often achieve good functional outcomes and can live in community settings after receiving appropriate rehabilitation services, although at higher costs and longer hospitalizations than younger individuals. The future of rehabilitation care for elderly patients after TBI is uncertain due to financial limitations associated with the implementation of the PPS payment system by CMS. Little is known regarding the long-term impact of TBI on individuals as they age, but this is an important issue as the population ages.
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Affiliation(s)
- Steven R Flanagan
- Department of Rehabilitation Medicine, Box 1240, Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029, USA.
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Lavoie A, Ratte S, Clas D, Demers J, Moore L, Martin M, Bergeron E. Preinjury warfarin use among elderly patients with closed head injuries in a trauma center. ACTA ACUST UNITED AC 2004; 56:802-7. [PMID: 15187746 DOI: 10.1097/01.ta.0000066183.02177.af] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to determine the impact of warfarin use on the severity of injury among elderly patients presenting with closed head injuries. METHODS A cohort of patients 55 years of age or older with closed head injuries taken to a tertiary trauma center between April 1993 and March 2001 was retrospectively identified. Patient characteristics, mechanism of injury, type and severity of injury, and hospital survival data were obtained from the trauma registry. Each case then was reviewed for completeness of information, assessment of preinjury warfarin use, and comorbidity. RESULTS Among the 384 patients presenting with closed head injuries, 35 (9%) were receiving warfarin before their trauma. As compared with nonusers, anticoagulated patients had a higher frequency of isolated head trauma (54% vs. 32%; p = 0.008), more severe head injuries (65.7% vs. 44.1%; p = 0.02), and a higher rate of mortality (40% vs. 21%, p = 0.01). These associations remained evident even after population differences in age, gender, comorbidities, and mechanism of injury were taken into account. Indeed, according to multivariate logistic regression models, warfarin use was associated with a statistically significant risk of death (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.22-6.12), statistically significant odds for more severe head injury (OR, 2.39; 95% CI, 1.10-5.17), and odds for isolated head injury that almost reached statistical significance (OR, 1.79; 95% CI, 0.82-3.90). CONCLUSIONS Among patients 55 years of age or older who present with closed head injury, the use of warfarin before trauma appears to be associated with a higher frequency of isolated head trauma, more severe head trauma, and a higher likelihood of death. The findings of this retrospective study support the concern about the adverse effects of anticoagulants in cases of head trauma.
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Affiliation(s)
- Andre Lavoie
- Choc-Trauma Montérégie, Hôpital Charles-LeMoyne, Greenfield Park, Quebec, Canada
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Abstract
BACKGROUND Age has long been recognized as a critical factor in predicting outcomes after head injury, with individuals older than 60 years predicted to have a worse outcome than those younger than 60. The object of this study was to determine the effect of age by decade of life beginning at birth in patients with head injuries of all levels of severity. STUDY DESIGN The New York State Trauma Registry was searched for head injuries from January 1, 1994 to December 31, 1995; the 13,908 cases found were placed into age groups by decade. Data were sought for each patient on demographics, Glasgow Coma Score, ICD-9 injury code, New Injury Severity Score (NISS), and mechanism of injury. These data were analyzed with chi-square and one-way ANOVA tests, with significance set at p < 0.05. RESULTS The risk of dying was significantly increased in patients beginning at 30 years of age compared with those in the younger age groups, with the greatest increases occurring after age 60 (p < 0.001). For the population with available Glasgow Coma Score data (n = 12,844), the mortality rate for patients ages 0 to 30 was 10.9%, and for patients ages 31 to 50 was 12.4%. The mean Glasgow Coma Score for nonsurvivors ages 0 to 20 (3.9) and for nonsurvivors ages 31 to 50 (5.1) were significantly different, with a risk ratio of 1.3 (p < 0.001). CONCLUSIONS The risk of dying for patients suffering head injuries increases as early as 30 years of age, making it necessary for health-care providers to consider increased monitoring and treatment for patients in this younger age group.
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Affiliation(s)
- Colin Harris
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
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Abstract
The Glasgow Coma Scale (GCS) was first introduced in the 1970s to provide a simple and reliable method of recording and monitoring change in the level of consciousness of head injured patients. Since its introduction, the GCS has been widely utilized in the trauma community and its use expanded beyond the original intentions of the score. In the context of traumatic injury, this paper discusses the use of the GCS as a predictor of outcome, the limitations of the GCS, the reliability of the GCS and potential alternatives through a critical review of the literature. The relevance to Australian trauma populations is also addressed.
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Affiliation(s)
- Belinda J Gabbe
- Trauma and Sports Injury Prevention Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Prahran, Vic. 3181, Australia.
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Susman M, DiRusso SM, Sullivan T, Risucci D, Nealon P, Cuff S, Haider A, Benzil D. Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. THE JOURNAL OF TRAUMA 2002; 53:219-23; discussion 223-4. [PMID: 12169925 DOI: 10.1097/00005373-200208000-00004] [Citation(s) in RCA: 298] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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 chi2 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 nonelderly 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.
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Affiliation(s)
- Mark Susman
- Department of Surgery, New York Medical College and Westchester Medical Center, Valhalla, New York 10595, USA
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Mattson MP, Chan SL, Duan W. Modification of brain aging and neurodegenerative disorders by genes, diet, and behavior. Physiol Rev 2002; 82:637-72. [PMID: 12087131 DOI: 10.1152/physrev.00004.2002] [Citation(s) in RCA: 285] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Multiple molecular, cellular, structural, and functional changes occur in the brain during aging. Neural cells may respond to these changes adaptively, or they may succumb to neurodegenerative cascades that result in disorders such as Alzheimer's and Parkinson's diseases. Multiple mechanisms are employed to maintain the integrity of nerve cell circuits and to facilitate responses to environmental demands and promote recovery of function after injury. The mechanisms include production of neurotrophic factors and cytokines, expression of various cell survival-promoting proteins (e.g., protein chaperones, antioxidant enzymes, Bcl-2 and inhibitor of apoptosis proteins), preservation of genomic integrity by telomerase and DNA repair proteins, and mobilization of neural stem cells to replace damaged neurons and glia. The aging process challenges such neuroprotective and neurorestorative mechanisms. Genetic and environmental factors superimposed upon the aging process can determine whether brain aging is successful or unsuccessful. Mutations in genes that cause inherited forms of Alzheimer's disease (amyloid precursor protein and presenilins), Parkinson's disease (alpha-synuclein and Parkin), and trinucleotide repeat disorders (huntingtin, androgen receptor, ataxin, and others) overwhelm endogenous neuroprotective mechanisms; other genes, such as those encoding apolipoprotein E(4), have more subtle effects on brain aging. On the other hand, neuroprotective mechanisms can be bolstered by dietary (caloric restriction and folate and antioxidant supplementation) and behavioral (intellectual and physical activities) modifications. At the cellular and molecular levels, successful brain aging can be facilitated by activating a hormesis response in which neurons increase production of neurotrophic factors and stress proteins. Neural stem cells that reside in the adult brain are also responsive to environmental demands and appear capable of replacing lost or dysfunctional neurons and glial cells, perhaps even in the aging brain. The recent application of modern methods of molecular and cellular biology to the problem of brain aging is revealing a remarkable capacity within brain cells for adaptation to aging and resistance to disease.
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Affiliation(s)
- Mark P Mattson
- Laboratory of Neurosciences, National Institute on Aging Gerontology Research Center, Baltimore, Maryland 21224, USA.
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Affiliation(s)
- A H Kaye
- Department of Neurosurgery and Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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