Traumatic Brain Injury among Older Adults at Level I and II Trauma Centers
Traumatic Brain Injury among Older Adults at Level I and II Trauma Centers
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DOI：
10.1089/neu.2013.3047
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发表时间：
2013-12-15
影响因子：
4.2
通讯作者：
Harrison-Felix, Cynthia
中科院分区：
文献类型：
--
作者：
Dams-O'Connor, Kristen;Cuthbert, Jeffrey P.;Harrison-Felix, Cynthia
65 岁及以上的人与创伤性脑损伤 (TBI) 相关的住院和死亡率最高，而老年人（不同研究的定义各不相同）在 TBI 后的预后特别差。预测这些结果的因素仍然知之甚少，并且不存在针对 TBI 的特定年龄护理指南。本研究利用国家创伤数据库 (NTDB) 2007 年至 2010 年间收集的数据对老年人 TBI 进行概述，利用美国人口普查数据评估特定年龄组 TBI 发生率随时间变化的趋势，并检验常规收集的信息是否能够预测 NTDB 中患有 TBI 的老年人的出院状况。结果显示，2007 年至 2010 年间，最高年龄组（75 岁以上）因 TBI 入院的创伤中心人数比一般人群增加了 20-25%。患有 TBI 的老年人（>=65 岁）往往是白人女性，她们因跌倒而受伤，导致头部严重简化损伤量表 (AIS) 评分。与年轻人相比，老年人接受了更多的住院治疗，例如神经影像学和神经外科手术，住院时间往往更长，并且更有可能需要持续的医疗护理。年龄较大、受伤严重程度和低血压会增加院内死亡的几率。随着婴儿潮一代的老龄化，老年人 TBI 的公共卫生负担可能会增加。需要改进该队列中 TBI 的一级和二级预防。
Individuals 65 years of age and over have the highest rates of traumatic brain injury (TBI)-related hospitalizations and deaths, and older adults (defined variably across studies) have particularly poor outcomes after TBI. The factors predicting these outcomes remain poorly understood, and age-specific care guidelines for TBI do not exist. This study provides an overview of TBI in older adults using data from the National Trauma Data Bank (NTDB) gathered between 2007 and 2010, evaluates age group-specific trends in rates of TBI over time using U.S. Census data, and examines whether routinely collected information is able to predict hospital discharge status among older adults with TBI in the NTDB. Results showed a 20-25% increase in trauma center admissions for TBI among the oldest age groups (those >=75 years), relative to the general population, between 2007 and 2010. Older adults (>=65 years) with TBI tended to be white females who have incurred an injury from a fall resulting in a severe Abbreviated Injury Scale (AIS) score of the head. Older adults had more in-hospital procedures, such as neuroimaging and neurosurgery, tended to experience longer hospital stays, and were more likely to require continued medical care than younger adults. Older age, injury severity, and hypotension increased the odds of in-hospital death. The public health burden of TBI among older adults will likely increase as the Baby Boom generation ages. Improved primary and secondary prevention of TBI in this cohort is needed.