Traumatic Brain Injury in an Aging Population
Traumatic Brain Injury in an Aging Population
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DOI：
10.1089/neu.2011.1995
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发表时间：
2012-04-01
影响因子：
4.2
通讯作者：
Colombo, Angelo
中科院分区：
文献类型：
--
作者：
Stocchetti, Nino;Paterno, Rosalia;Colombo, Angelo
创伤性脑损伤（TBI）的流行病学在几个西方国家正在发生变化，越来越多的老年TBI患者入住重症监护室（ICU）。我们描述了一系列的1366例成人患者入住三个神经ICU，其中44%的情况下是50岁或以上。老年患者创伤前的健康状况（使用APACHE评分）更差。在所有604例患者进行了颅内肿块的紧急切除术，硬膜外血肿更常见于年轻患者，硬膜下血肿更常见于老年患者。根据创伤后6个月的格拉斯哥结局量表（GOS）将结局分为有利（GOS评分4-5）或不利（GOS评分1-3）。50%的患者获得了良好的结局，但不良结局的比例随着年龄的增长而上升。死亡率是老年患者伤后6个月不良结局的主要原因。Logistic回归分析表明，几个参数独立的结果，包括格拉斯哥昏迷量表（GCS）的运动成分，瞳孔，CT结果，和早期低血压。此外，TBI前年龄和健康状况的比值比非常高。入住ICU的患者年龄越来越大，有合并症，并有特定类型的颅内病变。这些患者的早期抢救、手术治疗和重症监护可能会产生良好的结果，直到59岁，39%的60-69岁病例仍有可能获得良好的结果，而不会给严重残疾患者带来过度的负担。
The epidemiology of traumatic brain injury (TBI) is changing in several Western countries, with an increasing proportion of elderly TBI patients admitted to the intensive care unit (ICU). We describe a series of 1366 adult patients admitted to three neuro-ICUs in which 44% of cases were 50 years of age or older. The health status before trauma (rated using the APACHE score) was worse in older patients. In all 604 patients had emergency removal of intracranial masses, with extradural hematomas more frequent in young cases and subdural hematomas more frequent in older patients. Outcomes were classified according to the Glasgow Outcome Scale (GOS) 6 months post-trauma, as favorable (GOS score 4-5), or unfavorable (GOS score 1-3). Favorable outcomes were achieved by 50% of patients, but the proportions of unfavorable outcomes rose with age. Mortality was the main cause of unfavorable outcomes 6 months after injury in older patients. Logistic regression analysis indicates that several parameters independently contributed to outcome, including the motor component of the Glasgow Coma Scale (GCS), pupils, CT findings, and early hypotension. Additionally, the odds ratios were very high for age and health status before TBI. Patients admitted to the ICU are increasingly older, have co-morbidities, and have specific types of intracranial lesions. Early rescue, surgical treatment, and intensive care of these patients may produce excellent results up to the age of 59 years, with favorable outcomes still possible for 39% of cases aged 60-69 years, without an excessive burden of severely disabled patients.