Octogenarian Survival After Neurosurgical Procedures To Treat Severe Head Trauma

TY - JOUR

T1 - Octogenarian Survival After Neurosurgical Procedures To Treat Severe Head Trauma

AU - Ahmed, Nasim

AU - Kuo, Yen Hong

AU - Shin, Seung Hoon

N1 - Publisher Copyright: © 2022 Elsevier Inc.

PY - 2022/3

Y1 - 2022/3

N2 - Background: Falls are common for persons of advanced age and can result in severe traumatic brain injury (TBI). The purpose of the present study was to determine the survival benefit from aggressive operative intervention. Methods: The trauma quality improvement program database from 2013 to 2016 was accessed for the present study. All patients aged 80–89 years who had sustained a severe TBI with a Glasgow coma scale (GCS) score of ≤8 and brain abbreviated injury scale score of ≥3 and had undergone operative intervention (craniotomy or craniectomy) were included in the present study. The patients were divided into 2 groups, those who had survived and those who had died, and the characteristics, injury severity score (ISS), types of intracranial hemorrhage, and comorbidities were compared. Multivariable logistic regression analysis was performed to determine the factors associated with survival. A receiving operating characteristic curve was created to test the model, and the area under the curve was calculated. Results: Of the 1266 patients who had met the inclusion criteria for the present study, only 477 (37.68%) had survived. A lower ISS, higher GCS score, and no history of coagulopathy were factors indicating a greater chance of survival. Operative intervention for epidural hematoma, brain contusion, and subdural hematoma was associated with 3.5, 2.25, and 1.86 odds of survival, respectively. Procedure type (craniectomy vs. craniotomy) did not affect the outcome. The area under the curve was 0.723 (95% confidence interval, 0.694–0.752). Conclusions: The octogenarians who had undergone craniotomy or craniectomy for severe TBI after a fall had very high mortality. A lower ISS, higher GCS score, no history of coagulopathy and evacuation of subdural hematoma, epidural hematoma, or brain contusion indicated a greater probability of survival.

AB - Background: Falls are common for persons of advanced age and can result in severe traumatic brain injury (TBI). The purpose of the present study was to determine the survival benefit from aggressive operative intervention. Methods: The trauma quality improvement program database from 2013 to 2016 was accessed for the present study. All patients aged 80–89 years who had sustained a severe TBI with a Glasgow coma scale (GCS) score of ≤8 and brain abbreviated injury scale score of ≥3 and had undergone operative intervention (craniotomy or craniectomy) were included in the present study. The patients were divided into 2 groups, those who had survived and those who had died, and the characteristics, injury severity score (ISS), types of intracranial hemorrhage, and comorbidities were compared. Multivariable logistic regression analysis was performed to determine the factors associated with survival. A receiving operating characteristic curve was created to test the model, and the area under the curve was calculated. Results: Of the 1266 patients who had met the inclusion criteria for the present study, only 477 (37.68%) had survived. A lower ISS, higher GCS score, and no history of coagulopathy were factors indicating a greater chance of survival. Operative intervention for epidural hematoma, brain contusion, and subdural hematoma was associated with 3.5, 2.25, and 1.86 odds of survival, respectively. Procedure type (craniectomy vs. craniotomy) did not affect the outcome. The area under the curve was 0.723 (95% confidence interval, 0.694–0.752). Conclusions: The octogenarians who had undergone craniotomy or craniectomy for severe TBI after a fall had very high mortality. A lower ISS, higher GCS score, no history of coagulopathy and evacuation of subdural hematoma, epidural hematoma, or brain contusion indicated a greater probability of survival.

KW - Craniotomy or craniectomy

KW - Fall

KW - Octogenarian

KW - Severe traumatic brain injury

KW - Survival

UR - https://www.scopus.com/pages/publications/85122932365

U2 - 10.1016/j.wneu.2021.12.060

DO - 10.1016/j.wneu.2021.12.060

M3 - Article

C2 - 34954056

SN - 1878-8750

VL - 159

SP - e425-e430

JO - World Neurosurgery

JF - World Neurosurgery

ER -