Head injury mortality in a geriatric population: Differentiating an "Edge" age group with better potential for benefit than older poor-prognosis patients
Head injury mortality in a geriatric population: Differentiating an "Edge" age group with better potential for benefit than older poor-prognosis patients
复制标题
DOI：
10.1089/neu.2005.370
复制
发表时间：
2007-08-01
影响因子：
4.2
通讯作者：
Sakas, Damianos E.
中科院分区：
文献类型：
--
作者：
Bouras, Triantafyllos;Stranjalis, George;Sakas, Damianos E.
不同模式的老年人颅脑损伤治疗结果的比较对成本效益和医学伦理问题具有重要意义。在此，我们研究了老年头部创伤患者的死亡率，以确定将65 - 74岁的年轻老年患者与老年患者的“边缘”年龄组区分开来是否有效，考虑到强化治疗和手术干预可能带来的益处。我们收集了1926例头部创伤病例的数据，并将其分为三个年龄组：14-64岁，65 - 74岁和75岁或以上。然后，我们比较了这些组的损伤原因，损伤的严重程度，以及治疗是否包括入住重症监护室（ICU）或手术干预。我们发现，道路交通事故是年轻群体头部受伤的主要原因，而在老年人中，福尔斯则以跌倒为主。在所有头部损伤严重程度亚组中，老年人的死亡率较高。格拉斯哥昏迷量表（GCS）评分小于或等于8分的年轻受试者倾向于从ICU治疗中获益，而75岁及以上的患者则没有，无论他们的损伤严重程度如何。对于这些65-74岁年龄组的患者，数据表明可能会有一些益处。75岁及以上的患者在手术干预后存活的可能性明显低于年轻患者。我们的结论是，将65-74岁年龄组的患者与75岁及以上的患者作为一个单独的组进行治疗是有效的。老年人中的这一年轻亚组的患者可能受益于ICU治疗或手术干预。然而，我们的老年患者中的老年患者显然没有，他们的手术死亡风险显著较高。
A comparison of outcomes between different modes of head-injury treatment in the elderly has important bearing on questions of cost-effectiveness and medical ethics. Here, we have examined rates of mortality in elderly head-trauma victims to determine whether it is valid to differentiate an "edge" age group of younger elderly patients, 65 -74 years of age, from older elderly patients, considering possible benefit from intensive treatment and surgical intervention. We collected data from 1926 cases of head trauma and separated them into three age groups: 14-64 years, 65 -74 years, and 75 years or older. We then compared these groups with respect to cause of injury, severity of injury, and whether or not treatment included either admission to an Intensive Care Unit (ICU) or surgical intervention. We found that road traffic accidents were the major cause of head injury in the younger age group, whereas in the elderly falls predominated. Mortality was higher in the elderly in all the head injury severity subgroups. Young subjects with a Glasgow Coma Scale (GCS) score of less than or equal to 8 tended to benefit from ICU treatment whereas patients 75 and over did not, regardless of their severity of injury. For these patients who were in the 65-74 age group, the data suggested that some benefit was likely. Patients 75 and older were significantly less likely to survive surgical intervention than younger patients. We conclude that it is valid to treat patients in the age group 65-74 years as a separate group from those patients 75 and older. Patients in this younger subset of the elderly may benefit from ICU treatment or surgical intervention. However, the patients in our older subset of elderly patients clearly did not, and they had a significantly higher risk of surgical mortality.