Abstract Objective: To assess the prognosis of traumatic brain injury in elderly patients. Design: a prospective study. Methodology: Patients and methods this study was conducted on 50 elderly patients exposed to TBI in sohag university hospital and 50 patients exposed to TBI but less than 65 years used as a control.
Introduction It is widely known that global citizenry is continuing to age, Traumatic brain injury (TBI) is a significant problem in older adults. Adults aged 65 years and older have the highest rates of TBI-related hospitalization and death. Falls are the leading cause of TBI in elderly patients (56 %) and motor vehicle accidents (26%) are second followed by physical assault (18%).
Only (2%) of them managed. Older age is known to negatively influence outcome after TBI. Severity of trauma is determined by GCS at admission time, the lower the GCS at time of admission the severer the sequel. There is a prognostic significance of preadmission comorbidities, such as DM, HTN, anticoagulant, anti-platelets and associated body trauma.
Results In the absence of good clinical data, predicting outcomes and providing care to elderly patients with TBI remains problematic. Study group age were 65 to 75 years (mean 70 years), while the control group were 25 to 45 years (mean 35 years), More males were exposed to TBI in both study 72% (36 patients) and control groups 84 %( 42 patients), TBI in elderly was due to FFH 56 % (28 patients) followed by RTA 26% (13 patients) followed by physical assault 18 %( 9 patients), In the study group 18 %(9 patients ) were severely traumatized, 8% (4 patients ) were moderately traumatized and 74 % (37 patients) of them were mildly traumatized while in the control group 2% (1 patient) were severely raumatized,22%(11 patients ) &76% (38 patients) were moderately and mildly traumatized respectively , As regard other body trauma in the study group 10% (5 patients) had other body trauma (4 patients with orthopedic fractures and 1 patient with cardiothoracic trauma in the form of pneumothorax) when compared to 8% (4 patients with orthopedic fractures) of the control group, HTN and DM in the study group 56% (28 patients) and 20% (10 patients) were hypertensive and diabetic respectively compared to 8% (4 patients) and 16% (8 patients) respectively of the control group.
Tramadol addiction in the study group 2% (1 patient) were addicted compared to 18% (9 patients) of the control group, As regard antiplatelet 8 patients (16%) of study group were on antiplatelet 12 % (6 patients) developed acute SDH and 4 % ( 2 patients) developed intracerebral hemorrhage and one patient (2%) of control group was on antiplatelet who developed intracerebral hemorrhage but with anticoagulants 4 patients (8%) of study group were on anticoagulant and one patient (2%) of control group were on anticoagulant all of them developed intracerebral hemorrhage, age related functional changes in the study group 8% (4 patients) were having age related changes like diminution of hearing 6% (3 patients) and visual disorder 8% (4 patients) compared to 0% (zero patients) of the control group, In the study group 98% (49 patients) were managed conservatively and 1 patient underwent surgery (elevation of CDF) , compared to 90% (45 patients) of control group were managed conservatively and surgery in 10 % in the form of elevation of depressed fracture for 2 patients (4%) and evacuation of EDH for 3 patients (6%), Longer admission time in elderly patients (Mean ±SD 3.78±3.86) when compared to younger adults (Mean ±SD3.08±2.71),Study group exposed to TBI had GOS of 78 %( 39 patients) with good recovery and 22% (11 patients) died while the control group had 98 %( 49 patients) with good recovery and 2% (1 patient) died.
In conclusion: The leading causes of head injury in older adults are falls, motor vehicle accidents and assaults come next, Low Glasgow Coma Scale and severity of injury is a predictor for increased mortality and morbidity following TBI regardless of age. The combination of chronic disease and brain injury in older adults contributes to poorer recovery and higher mortality rates.