Geriatric Patients with Traumatic Brain Injury

Association Between Comorbidities, Nutritional Status, and Anticlotting Drugs and Neurologic Outcomes in 

via World Neurosurgery

Publication date: September 2016
Source:World Neurosurgery, Volume 93
Author(s): Tomoya Okazaki, Toru Hifumi, Kenya Kawakita, Ryuta Nakashima, Atsushi Matsumoto, Hajime Shishido, Daiske Ogawa, Masanobu Okauchi, Atsushi Shindo, Masahiko Kawanishi, Takashi Tamiya, Yasuhiro Kuroda
BackgroundSeveral studies using trauma data banks and registers showed that age, Glasgow Coma Scale (GCS), Injury Severity Score, and intraventricular hemorrhage were independent factors for neurologic outcomes in geriatric patients with traumatic brain injury (TBI). However, these analyses did not comprehensively evaluate factors particularly associated with geriatric patients. We aimed to identify factors particularly associated with geriatric patients that affect neurologic outcomes in TBI.MethodsPatients aged ≥65 years who were hospitalized consecutively in Kagawa University Hospital with severe TBI between 1 January 2008 and 31 October 2015 were retrospectively reviewed. We evaluated background factors particularly associated with geriatric patients, including comorbidities (Charlson Comorbidity Index [CCI]), nutritional status (serum albumin level), and presence/absence of antiplatelet and anticoagulant drugs, in addition to baseline characteristics. Multivariate analyses were performed to identify independent predictors of unfavorable neurologic outcomes (UO), as defined as a Glasgow Outcome Scale score of 1–3 at discharge from hospital. The association between CCI and UO was evaluated in a subgroup analysis.ResultsUO occurred in 65.0% of 140 patients. Multivariate analyses showed that the CCI (odds ratio, 1.91; 95% confidence interval, 1.21–3.29; P = 0.011), age, and GCS were independent predictors of UO. In subgroup analyses of patients with an initial GCS score of 13–15, the rate of UO significantly increased with CCI score (CCI 0, 35.5%; CCI 1 or 2, 39.4%; CCI >2, 83.3%; P < 0.01).ConclusionsCCI was an independent predictor of UO in geriatric patients with severe TBI.

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