Operative intervention for traumatic brain injuries in the elderly

Abstract

INTRODUCTION: The management of traumatic brain injuries (TBI) in the elderly (age ≥ 65 years) is a constant dilemma in neurosurgery. Advanced age is associated with poor clinical outcome as well as poor rehabilitation potential. The benefit of operative intervention in this group of patients is controversial. The aim of this study is to investigate for factors which may predict outcome of operative treatment in elderly patients with severe head injuries. METHOD: A retrospective analysis was conducted on 68 elderly patients who had been operated on for TBI in a designated trauma center from 2006 to 2010. The impact of patients’ age, pre-operative GCS, papillary responses, imaging findings, pre-existing medical conditions, and the use of anticoagulant/antiplatelet agents on patient outcomes were studied. Clinical outcome measures were hospital mortalities, GCS, and Glasgow Outcome Score (GOS) upon hospital discharge. RESULTS: The overall mortality rate was 55.9%. Old age, abnormal papillary response, low pre-operative GCS, the presence of midline shift and obliteration of cistern on CT were associated with poor survival. Upon further subgroup analysis, age was a prognostic factor but should not be a limiting factor for operation-patient aged 70 – 79 with normal bilateral papillary response still had a overall survival rate of 86.6% and good outcomes (GOS 4 or 5) in 53.3% of patients. Abnormal papillary response in at least one eye and pre-operative GCS < 13 were associated with very poor prognosis. Pre-operative GCS was positively correlated with GCS upon discharge. CONCLUSION: Elderly TBI patients with normal bilateral papillary responses and GCS ≥ 13 were found to have a good chance of achieving good functional survival after aggressive operative intervention. The latter should not be withheld based on patients’ age alone.