Outcome and its predictors in traumatic brain injury in elderly population: Institutional study from Northern India

Abstract

Introduction:Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Survival and functional outcome is significantly poor in the elderly population. There is a need to develop better geriatric specific prognostic models and evidence-based geriatric traumatic brain injury management protocols for better treatment, rehabilitation, and prevention.Aims and objectives:To study the frequency, outcome and correlates of traumatic brain injury in elderly patients.Material and Methods:Frequency, outcome and correlates of traumatic brain injury in patients more than 65 years of age admitted in tertiary care hospital were studied in 160 patients admitted between 1st January 2016 and 31st December 2016 (retrospective analysis) and between 1st January 2017 and 30th June 2018 (prospective analysis). Institutional ethical committee approval was taken.Results:This study concluded that road side accident was the most common cause of traumatic brain injury in elderly in this study. Incidence of traumatic brain injury in elderly was found to be 11.45%. Both non-reacting pupils and low Glasgow coma scale on arrival were significantly associated with poor outcome in terms of mortality. Most of the patients who expired or were discharged against medical advice had associated skull bone fractures, cerebral infarct, diffuse brain edema, subarachnoid hemorrhage, midline shift, lower hemaglobin, higher random blood sugar and higher creatinine as compared to patients who were discharged. All these findings were statistically significant.Conclusion:Low Glasgow coma scale on arrival, non reacting pupils, low hemoglobin, high random blood sugar, high creatinine and intubation on arrival are associated with increased mortality. Associated skull bone fractures, cerebral infarct, diffuse brain edema are predictors of poor outcome. Anticoagulants and associated co-morbidities do not increase the risk of mortality in traumatic brain injury in elderly.