Outcome in Moderate and Severe Traumatic Brain Injury among Elderly Individuals Analytical Study in Government Rajaji Hospital Madurai
Keywords:
Diffuse axonal injury, Extradural hemorrhage, Glasgow coma scale, Intracerebral hemorrhage, Intracranial pressure, Sub arachnoid hemorrhage, Sub dural hemorrhage, Traumatic brain injury
Abstract
Background: Head injuries are among the most common types of trauma encountered in emergency department. Many
patients with severe brain injuries die before reaching a hospital; in fact, nearly 90% of pre hospital trauma related deaths
involve brain injury.
Objectives: Aim of the study was to study the age as an important prognostic factor in the prediction of outcome in Head
Injury patients, to find out the incidence and type of traumatic intracranial lesions in the elderly, to study and analyze the cause
of head injury among elderly patients, and to compare conservative, medical, emergency surgical treatment, and outcome.
Results: The poor outcome at all levels in the elderly patients, even with good Glasgow coma scale (GCS) on admission.
Although they have lower impact injuries and multiple injuries, their computed tomography scan show more number of intracranial
mass lesions, sub arachnoid hemorrhage, and midline shift. Age has been cited as a significant risk factor for the poor outcome
in this study.
Conclusion: The mortality rate increases with age mainly from the medical complications to prolonged coma. GCS is a good
reliable predictor of prognosis even in the 1st day after admission. If the doctors are persuaded to elicit and record them carefully,
predictions can be made reasonably accurate at the bed side
References
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Marcincin RP. Diffuse axonal injuryand traumatic coma in the primate. Ann
Neurol 1985;12:564-74.
2. Balasubramani V, Ramesh VG. A case of coup and contrecoup extradural
hematoma. Surg Neurol 1991;36:462-4.
3. Baltas I, Gerogiannis N, Sakellariou P, Matamis D, Prassas A, Fylatakis M.
Outcome in severly head injured patients with and without multiple trauma.
J Neusurg Sci 1998;42:85-8.
4. Baltas I, Gerogiannis N, Sakellariou P, Matamis D. Outcome in severe
head injured patients with and without multiple trauma. J Neusurg Sci
1998;42:85-8.
5. Baradham G, Dennyson WG. Delayed traumatic intracerebral hemorrhage.
J Neurol Neusurg Psychiat 1972;35:698-701.
6. Baxt WG, Moody P. The differential survival ofrauma patients. J Trauma
1987;27:602-6.
7. Bocker DP, Miller JD, Ward JD, Sullivan HG, Adams WE, Rosner MJ.
Significance of intra crania hypertension in severe head injury. J Neusurg
1997;47:503-16.
8. Bocker DP, Miller JD, Ward JD, young HF. The outcome from severe
head injury with early diagonosis and intensive management. J Neurosurg
1977;47:491-502.
9. Bocker DP. Acute sub Dural Hematoma. Neu Trauma. New York: Springer,
Verlag; 1986. p. 51-95.
10. Brakkman R, Gelpke GJ, Habbema JD, Mass AI, Minderhould JM.
Systematic selection of prognostic featuers in patients with severe head
injury. Neurosurgery 1980;6:362-70.
11. Bullock HR, Povlishock JT, Povlishock JT. Guidelines for the management
of severe head injury. J Trauma 1996;13:639-731.
12. Carlsson CA, Von essen C, Lofgnen J. Factors affecting the clinical course
the patients with severe head trauma. J Neusurg 1968;29:242-52.
13. Chagle A, Muzundar D, Goel A. A massive extradural haematoma at the
vertex. Neurol India 2000;48:88.
14. Cardibacs F, Labato RD, Rivas JJ, Chowdhury FH, Ashadullah AT,
Sarkar MH, et al. EDH observations. J Neurosurg Sci 1981;54:179-86.
15. Druce DA, Schut L, Bruno LA, Wood JH, Sutton LN. Outcome following
severe head injuries. J Neurol Surg 1978;48:679-88.
16. Fell DA, Fitzerald S, Moiel RH, Caram P. Acute sub dural hematoma
review of 144-cases. J Neurol Surg 1975;42:37-42.
17. Gudeman SK, Kishore PR, Miller JD, et al. Traumatic head injury outcome.
Neurol Surg 1979;5:309-13.
18. Gutterman P, Shenkin HA. Progonostic features in recovery from traumatic
decerbration J Neurol Surg 1970;32:330-5.
19. Kanen OH. Epidural hematoma. Surg Neurol 1975;4:23-6.
20. Hernesniemi J. Outcome follosing head injuries in the aged. Acta Neuchir
(Wien) 1979;49:67-79.
21. Hooper R. Observations on on extradural haemorrhage. Br J Surg
1959;47:71-87.
22. Howard MA 3rd, Gross AS, Dacey RG Jr., Winn HR. Acute sub dural
hematomas: An Age dependent clinical entity. J Neurosurg 1989;71:858-63.
23. Jacobson W. On middle meningeral hemorrhage, Guys Hosp Rep
1886;43:147-208.
24. Jamieson KG, Yelland JD. Surgically treated traumatic sub dural
hematomas. J Neusurg 1972;37:137-49.
25. Jennett B, Bond MR. Assessment of outcome after severe brain damage.
Lancet 1975;1:480-4.
26. Jennett B, Teasdale G. Management of Head Injuries. Philadelphia, PA: FA
Davis Co.; 1981.
27. Jennett B, Teasdale G. Aspects of coma after severe head injury. Lancet.
1977;1:878-81.
28. Jennett B, Teasdale G, Braakman R, Minderhoud J, Jones RK. Predicting
outcome in individual patients after severe head injury. Lancet
1976;1:1031-4.
29. Jennett B, Teasdale G, Pickard J, Grant H, Braakman R, Mass A, et al.
Severe head injuries in three countries. J Nerol Neusurg Psychiatry
1977;40:291-8.
30. Jennett B, Teasdale G., Braakman R. Prognosis of patients with severe head
injury. J Neusurg 1979;4:283-9.
31. Johnston IH, Johnston JA, Jennett WB. Intra cranial pressures following
head injury. Lancet 1970;2:433-6.
32. Kawanata T, Takeshita M, Kubo O, et al. Management of intracerebral
hemorrhage associated with oral anti-coagulant therapy. Surg Nerol
1995;44:438-42.
33. Kilaru S, Garb J, Emhoff T, Fiallo V, Simon B, Swiencicki T, et al. Longterm
functional status and morality of elderly patients with severe closed
head injuries. J Trauma 1996;41:957-63.
34. Kjillberg RN, Prieto A. Bifrontal decompressive craniotomy for massive
cerebral oedema. J Neusurg 1971;34:448-93.
35. Kotwica Z, Jakubowski JK. Acute head injuries in the elderly. An analysis
of 136 consecutive patients. Acta Neurochir (Wien) 1992;118:98-102.36. Langfitt TW. Measuring the outcome from head injuries. J Neusurg
1978;48:673-8.
37. Lew TW, Ng I, Yeo TT, Scow WT, Tan KK, Ong PL, et al. Outcome of
patients with traumatic injury managed on a standardized head injury
protocol. Ann Acad Med Singapore 1998;27:332-9.
38. Mahapatra AK, Bansal S. Role of intracranial pressure monitoring in head
injury: A prospective study. Neurol India 1998;46:109-14.
39. Marshall LF, Ruff RM, Crouch J, Klauber MR, Levin HS, Barth J, et al.
Predictors of outcome following severe head trauma: Follow up data from
traumatic coma data bank. Brain Inj 1993;66:20-5.
40. Marshall LF, Gautille T, Klauber MR, Marshall LF. The outcome of severe
closed head injury. J Newsurg 1991;75:528-36.
41. Marshall LF, Marshall SB, Klauber MR, Clarke M, Vanbuham,
Eisenberg HM, et al. A classification head injury based on CT. J Neusurg
1991;75:14-20.
42. Miller JD, Butterworth JF, Gudeman SK, Faulkner JE, Choi SC, Selhorst JB,
et al. Further experience in the treatment of severe head injury. J Neusurg
1981;54:289-99.
43. Ommaya AK, Cennarelli TA. Cerebral concussion and traumatic
unconsciousness: Correlation of experimental and clinical observations of
blunt head injuries. Brain 1974;97:633-54.
44. Overgaard J, Hvid-Hansen O, Land AM, Pedersen KK, Christensen S,
Haase J, et al. Prognosis after head injury based early clinical examination.
Lancet 1973;2:631-5.
45. Pazzaglia P, Frant F, Frank G, Gaint G. Clinical course and prognosis of
acute post traumatic coma. J Neurol Neurosurg Psychiatry 1975;38:149-54.
46. Pentland B, Jones OA, Roy CW, Miller JD. Head injury in the elderly. Age
Ageing 1986;15:193-202.
47. Pickard JD, Bailey S, Sanderson SH, Rees M, Garfield JS. Steps towards
cost benefit analysis of regional neuro surgical care. BMJ 1990;301:629-35.
48. Ramamurthy B, Acute SD. Hand Book Clinical Neurology. Amsterdam,
Netherlands: Elsevier; 1976. p. 275-96.
49. Reale F, Deltini R, Maneattini G. EDH. J Neusurg Sci 1984;28:9-16.
50. Rivano C, Borzone M, Carta F, Michellozzi G. Traumatic intracerebral
hematomas. 72 cases surgically treated. J Neusurg Sci 1980;24:77-84.
51. Servadei F, Murray GD, Teasdale GM, Dearden M, Ianotti F, Lapierre F,
et al. Traumatic sub arachnoid hemorrhage: Demographic and clinical study
of 750 patients from the European brain injury consortium survey of head
injuries. Neurosurgery 2002;50:261-9.
52. Strich S. Shearing of nerve fibers as a cause of brain damage due to head
injury. Lancet 1961;2:443-8.
53. Strich S. Diffuse degeneration of cerebral white matter in severe dementia
following head injury. J Neurol Neusurg Psychiatry 1956;19:163-85.
54. Subramania MV, Prasad GB, Rao BD. Bilateral Epidural hematomas. Br J
Surg 1975;62:397-400.
55. Tandon PN. Management of head injury: Fads and Fashions and facts.
Neurol India 1986;34:1-30.
56. Tandon PN. Acute subdural hematomas a reappraisal. Neurol India
2001;49:3-10.
57. Teasdale G, Jennet B. Assessment of coma and impaired consciousness.
A practical scale. Lancet 1974;2:81-4.
58. The Brain Trauma Foundation. The American Association of Neurological
Surgeons. The Joint section on neuro trauma and critical age. J Neurotrauma
2000;17:573-81.
59. Thibault LE, Gennarelli TA. Bio mechanics of Acute sub dural hematomas.
J Trauma 1982;22:680-6.
60. Vollmer DG, Torner JC, Eisenberg HM, Foulkes MA, Marmarou A,
Marshall LF. Age and outcome following traumatic comas: Why do older
patients fare worse? J Neurosurg Atlas 1991;5:37-49.
61. Wilberger JE Jr., Harris M, Diamond D. Acute sub dural hematoma:
Morbidity, mortality, and operative timing. J Neurosurg 1991;74:212-8.
62. Wilberger JE, Harris M, Diamond DL. Acute SDH mortality, morbidity and
operative timing. J Neurol Surg 1991;74:212-8.
63. Wintzen AR, Dejonge H, Loeliger EA, Bots GT. The risk of ICH during oral
anticoagulant treatment. Ann Neurol 1984;16:553-8.
64. Wright RL. Traumatic hematomas of the posterior cranial fossa. J Neurol
Surg 1966;24:402-9.
65. Yad YR, Basoor A, Jain G, Nelson A. Expanding traumatic intracerebral
contusion/hematoma. Neurol India 2006;54:377-81.
66. Zimmerman RA, Bilaniuk LT, Gennarelli T, Bruce D, Dolinskas C,
Uzzell B. CT in the diagnosis and treatment of acute head injury. AJR Am J
Roentgenol 1978;131:27-34.
67. Zucarello M, Pardatscher K, Andrioli GC, Fiore DL, Iavicoli R, Cervellini P.
EDH of Posterior cranial fossa. Neu Surg 1981;8:434-7.
Marcincin RP. Diffuse axonal injuryand traumatic coma in the primate. Ann
Neurol 1985;12:564-74.
2. Balasubramani V, Ramesh VG. A case of coup and contrecoup extradural
hematoma. Surg Neurol 1991;36:462-4.
3. Baltas I, Gerogiannis N, Sakellariou P, Matamis D, Prassas A, Fylatakis M.
Outcome in severly head injured patients with and without multiple trauma.
J Neusurg Sci 1998;42:85-8.
4. Baltas I, Gerogiannis N, Sakellariou P, Matamis D. Outcome in severe
head injured patients with and without multiple trauma. J Neusurg Sci
1998;42:85-8.
5. Baradham G, Dennyson WG. Delayed traumatic intracerebral hemorrhage.
J Neurol Neusurg Psychiat 1972;35:698-701.
6. Baxt WG, Moody P. The differential survival ofrauma patients. J Trauma
1987;27:602-6.
7. Bocker DP, Miller JD, Ward JD, Sullivan HG, Adams WE, Rosner MJ.
Significance of intra crania hypertension in severe head injury. J Neusurg
1997;47:503-16.
8. Bocker DP, Miller JD, Ward JD, young HF. The outcome from severe
head injury with early diagonosis and intensive management. J Neurosurg
1977;47:491-502.
9. Bocker DP. Acute sub Dural Hematoma. Neu Trauma. New York: Springer,
Verlag; 1986. p. 51-95.
10. Brakkman R, Gelpke GJ, Habbema JD, Mass AI, Minderhould JM.
Systematic selection of prognostic featuers in patients with severe head
injury. Neurosurgery 1980;6:362-70.
11. Bullock HR, Povlishock JT, Povlishock JT. Guidelines for the management
of severe head injury. J Trauma 1996;13:639-731.
12. Carlsson CA, Von essen C, Lofgnen J. Factors affecting the clinical course
the patients with severe head trauma. J Neusurg 1968;29:242-52.
13. Chagle A, Muzundar D, Goel A. A massive extradural haematoma at the
vertex. Neurol India 2000;48:88.
14. Cardibacs F, Labato RD, Rivas JJ, Chowdhury FH, Ashadullah AT,
Sarkar MH, et al. EDH observations. J Neurosurg Sci 1981;54:179-86.
15. Druce DA, Schut L, Bruno LA, Wood JH, Sutton LN. Outcome following
severe head injuries. J Neurol Surg 1978;48:679-88.
16. Fell DA, Fitzerald S, Moiel RH, Caram P. Acute sub dural hematoma
review of 144-cases. J Neurol Surg 1975;42:37-42.
17. Gudeman SK, Kishore PR, Miller JD, et al. Traumatic head injury outcome.
Neurol Surg 1979;5:309-13.
18. Gutterman P, Shenkin HA. Progonostic features in recovery from traumatic
decerbration J Neurol Surg 1970;32:330-5.
19. Kanen OH. Epidural hematoma. Surg Neurol 1975;4:23-6.
20. Hernesniemi J. Outcome follosing head injuries in the aged. Acta Neuchir
(Wien) 1979;49:67-79.
21. Hooper R. Observations on on extradural haemorrhage. Br J Surg
1959;47:71-87.
22. Howard MA 3rd, Gross AS, Dacey RG Jr., Winn HR. Acute sub dural
hematomas: An Age dependent clinical entity. J Neurosurg 1989;71:858-63.
23. Jacobson W. On middle meningeral hemorrhage, Guys Hosp Rep
1886;43:147-208.
24. Jamieson KG, Yelland JD. Surgically treated traumatic sub dural
hematomas. J Neusurg 1972;37:137-49.
25. Jennett B, Bond MR. Assessment of outcome after severe brain damage.
Lancet 1975;1:480-4.
26. Jennett B, Teasdale G. Management of Head Injuries. Philadelphia, PA: FA
Davis Co.; 1981.
27. Jennett B, Teasdale G. Aspects of coma after severe head injury. Lancet.
1977;1:878-81.
28. Jennett B, Teasdale G, Braakman R, Minderhoud J, Jones RK. Predicting
outcome in individual patients after severe head injury. Lancet
1976;1:1031-4.
29. Jennett B, Teasdale G, Pickard J, Grant H, Braakman R, Mass A, et al.
Severe head injuries in three countries. J Nerol Neusurg Psychiatry
1977;40:291-8.
30. Jennett B, Teasdale G., Braakman R. Prognosis of patients with severe head
injury. J Neusurg 1979;4:283-9.
31. Johnston IH, Johnston JA, Jennett WB. Intra cranial pressures following
head injury. Lancet 1970;2:433-6.
32. Kawanata T, Takeshita M, Kubo O, et al. Management of intracerebral
hemorrhage associated with oral anti-coagulant therapy. Surg Nerol
1995;44:438-42.
33. Kilaru S, Garb J, Emhoff T, Fiallo V, Simon B, Swiencicki T, et al. Longterm
functional status and morality of elderly patients with severe closed
head injuries. J Trauma 1996;41:957-63.
34. Kjillberg RN, Prieto A. Bifrontal decompressive craniotomy for massive
cerebral oedema. J Neusurg 1971;34:448-93.
35. Kotwica Z, Jakubowski JK. Acute head injuries in the elderly. An analysis
of 136 consecutive patients. Acta Neurochir (Wien) 1992;118:98-102.36. Langfitt TW. Measuring the outcome from head injuries. J Neusurg
1978;48:673-8.
37. Lew TW, Ng I, Yeo TT, Scow WT, Tan KK, Ong PL, et al. Outcome of
patients with traumatic injury managed on a standardized head injury
protocol. Ann Acad Med Singapore 1998;27:332-9.
38. Mahapatra AK, Bansal S. Role of intracranial pressure monitoring in head
injury: A prospective study. Neurol India 1998;46:109-14.
39. Marshall LF, Ruff RM, Crouch J, Klauber MR, Levin HS, Barth J, et al.
Predictors of outcome following severe head trauma: Follow up data from
traumatic coma data bank. Brain Inj 1993;66:20-5.
40. Marshall LF, Gautille T, Klauber MR, Marshall LF. The outcome of severe
closed head injury. J Newsurg 1991;75:528-36.
41. Marshall LF, Marshall SB, Klauber MR, Clarke M, Vanbuham,
Eisenberg HM, et al. A classification head injury based on CT. J Neusurg
1991;75:14-20.
42. Miller JD, Butterworth JF, Gudeman SK, Faulkner JE, Choi SC, Selhorst JB,
et al. Further experience in the treatment of severe head injury. J Neusurg
1981;54:289-99.
43. Ommaya AK, Cennarelli TA. Cerebral concussion and traumatic
unconsciousness: Correlation of experimental and clinical observations of
blunt head injuries. Brain 1974;97:633-54.
44. Overgaard J, Hvid-Hansen O, Land AM, Pedersen KK, Christensen S,
Haase J, et al. Prognosis after head injury based early clinical examination.
Lancet 1973;2:631-5.
45. Pazzaglia P, Frant F, Frank G, Gaint G. Clinical course and prognosis of
acute post traumatic coma. J Neurol Neurosurg Psychiatry 1975;38:149-54.
46. Pentland B, Jones OA, Roy CW, Miller JD. Head injury in the elderly. Age
Ageing 1986;15:193-202.
47. Pickard JD, Bailey S, Sanderson SH, Rees M, Garfield JS. Steps towards
cost benefit analysis of regional neuro surgical care. BMJ 1990;301:629-35.
48. Ramamurthy B, Acute SD. Hand Book Clinical Neurology. Amsterdam,
Netherlands: Elsevier; 1976. p. 275-96.
49. Reale F, Deltini R, Maneattini G. EDH. J Neusurg Sci 1984;28:9-16.
50. Rivano C, Borzone M, Carta F, Michellozzi G. Traumatic intracerebral
hematomas. 72 cases surgically treated. J Neusurg Sci 1980;24:77-84.
51. Servadei F, Murray GD, Teasdale GM, Dearden M, Ianotti F, Lapierre F,
et al. Traumatic sub arachnoid hemorrhage: Demographic and clinical study
of 750 patients from the European brain injury consortium survey of head
injuries. Neurosurgery 2002;50:261-9.
52. Strich S. Shearing of nerve fibers as a cause of brain damage due to head
injury. Lancet 1961;2:443-8.
53. Strich S. Diffuse degeneration of cerebral white matter in severe dementia
following head injury. J Neurol Neusurg Psychiatry 1956;19:163-85.
54. Subramania MV, Prasad GB, Rao BD. Bilateral Epidural hematomas. Br J
Surg 1975;62:397-400.
55. Tandon PN. Management of head injury: Fads and Fashions and facts.
Neurol India 1986;34:1-30.
56. Tandon PN. Acute subdural hematomas a reappraisal. Neurol India
2001;49:3-10.
57. Teasdale G, Jennet B. Assessment of coma and impaired consciousness.
A practical scale. Lancet 1974;2:81-4.
58. The Brain Trauma Foundation. The American Association of Neurological
Surgeons. The Joint section on neuro trauma and critical age. J Neurotrauma
2000;17:573-81.
59. Thibault LE, Gennarelli TA. Bio mechanics of Acute sub dural hematomas.
J Trauma 1982;22:680-6.
60. Vollmer DG, Torner JC, Eisenberg HM, Foulkes MA, Marmarou A,
Marshall LF. Age and outcome following traumatic comas: Why do older
patients fare worse? J Neurosurg Atlas 1991;5:37-49.
61. Wilberger JE Jr., Harris M, Diamond D. Acute sub dural hematoma:
Morbidity, mortality, and operative timing. J Neurosurg 1991;74:212-8.
62. Wilberger JE, Harris M, Diamond DL. Acute SDH mortality, morbidity and
operative timing. J Neurol Surg 1991;74:212-8.
63. Wintzen AR, Dejonge H, Loeliger EA, Bots GT. The risk of ICH during oral
anticoagulant treatment. Ann Neurol 1984;16:553-8.
64. Wright RL. Traumatic hematomas of the posterior cranial fossa. J Neurol
Surg 1966;24:402-9.
65. Yad YR, Basoor A, Jain G, Nelson A. Expanding traumatic intracerebral
contusion/hematoma. Neurol India 2006;54:377-81.
66. Zimmerman RA, Bilaniuk LT, Gennarelli T, Bruce D, Dolinskas C,
Uzzell B. CT in the diagnosis and treatment of acute head injury. AJR Am J
Roentgenol 1978;131:27-34.
67. Zucarello M, Pardatscher K, Andrioli GC, Fiore DL, Iavicoli R, Cervellini P.
EDH of Posterior cranial fossa. Neu Surg 1981;8:434-7.
Published
2021-09-30
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