Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality worldwide. Elderly populations (those over 65 years old) are at particularly high risk of death or disability after sustaining TBI, and they typically need more hospice care and rehabilitation following injury than younger populations.

As a result, researchers are investigating new ways to measure and predict outcomes in elderly patients who present to the emergency department with TBI. These prediction techniques, which are administered in the emergency department, inform clinical decision-making and can provide valuable tools for family counseling and resource allocation. Currently, the Glasgow Coma Scale (GCS), the Abbreviated Injury Scale (AIS), and computed tomography (CT; a brain imaging technology) exist as prognostic models for TBI, but to date there is no measure for predicting respiratory failure or neurological in elderly patients with severe TBI.

A recent Austrian study sought to fill this gap by determining prognostic factors for outcomes in elderly patient populations. Researchers collected hospital records from 596 elderly patients who presented to a level I trauma center with severe TBI. They found that the following factors significantly increase the mortality rate among elderly TBI patients:

  • Respiratory failure;
  • pupillary response, the eye’s automatic response to light stimulus;
  • injury severity score; and
  • midline shift, which occurs when the brain’s natural center point shifts to the left or the right as a response to physical trauma.

In addition to existing predictive tools for injury outcomes in elderly populations, these physical factors can provide clinicians with valuable prognostic information in the emergency department. After sustaining severe TBI, the elderly are at high risk for mortality and morbidity. Early prognosis can allow clinicians to formulate appropriate treatment plans to ensure the highest standard of care and quality of life for these patients.

Ostermann RC, Joestl J, Tiefenboeck T, et al. Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury. Journal of Orthopedic Surgery and Research. (November 2018).


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