Page 41 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Decision-making in very severe traumatic brain injury
Elderly patients
Five studies focusing on elderly patients matched our criteria (Table IV) 18, 20, 52-54
and three articles from other categories contained information concerning elderly 2 patients.22, 31, 38
Mortality rates ranged between 53.6% (6 month) and 77% (1 year) for all GCS scores.52,
53 For this severity group, surgical management resulted in lower mortality compared
to conservative treatment (32.9% vs. 88.1% and 62% vs. 81%).18, 52 For vs-TBI patients,
results are worse, with rates around 80% even up to 100% after DC.18, 20, 53, 54 An earlier
discussed study found better outcome in patients younger than 66 years old, which
seemed to be a cut-off point, since groups aged <40 and 40-65 showed no differences.38
Almost 6% of GCS 3-4 patients achieved functional recovery (GOS 4-5) 6-months after evacuation of an ASDH.54 In another study, GCS 3-4 patients achieved 11% favorable outcome (GOS 4-5) one year after >80% received non-specified neurosurgical intervention.20 Our biggest included cohort showed only 3% of vs-TBI patients with favorable outcome, compared to 13% with less severe injury (GCS 6-15).18 Both positive and negative association of surgical intervention with outcome was reported.18, 20, 52, 53 GCS Score was an important outcome predictor 18, 52-54 and other factors associated with unfavorable outcome are treatment method, pupillary abnormality, higher trauma severity, closed basal cisterns (100% mortality) and midline shift (≥10 or ≥15 mm) on first CT-scan.20, 52 Age was said to be both a significant 18, 54 and insignificant predictor 53 and also gender associations remained non-conclusive.20, 53
39