Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury

Abstract Background Traumatic brain injury (TBI), particularly in the elderly patient population, is known to be the single largest cause of death and disability worldwide. The purpose of this retrospective study was to evaluate clinical factors predicting poor outcome with special emphasis on the i...

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Main Authors: Roman C. Ostermann, Julian Joestl, Thomas M. Tiefenboeck, Nikolaus Lang, Patrick Platzer, Marcus Hofbauer
Format: Article
Language:English
Published: BMC 2018-11-01
Series:Journal of Orthopaedic Surgery and Research
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13018-018-0975-y
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author Roman C. Ostermann
Julian Joestl
Thomas M. Tiefenboeck
Nikolaus Lang
Patrick Platzer
Marcus Hofbauer
author_facet Roman C. Ostermann
Julian Joestl
Thomas M. Tiefenboeck
Nikolaus Lang
Patrick Platzer
Marcus Hofbauer
author_sort Roman C. Ostermann
collection DOAJ
description Abstract Background Traumatic brain injury (TBI), particularly in the elderly patient population, is known to be the single largest cause of death and disability worldwide. The purpose of this retrospective study was to evaluate clinical factors predicting poor outcome with special emphasis on the impact of respiratory failure (RF) on mortality in elderly patients with isolated severe TBI. Methods All elderly patients (age ≥ 65 years) with isolated severe head injury, admitted to this level I trauma center, during a period of 18 years (from January 1992 to December 2010) were identified from the trauma registry. The medical records were reviewed for demographics, mechanism of injury (MOI), GCS score at admission, RF, pupillary light reflex (LR), CT findings (subdural hematoma, subarachnoid hematoma, edema, midline-shift), and whether there was conservative treatment or surgical intervention and the Glasgow Outcome Score (GOS) at hospital discharge. Stepwise logistic regression analysis was used to identify risk factors for a poor prognosis and outcome. Results The following variables influenced the mortality: respiratory failure, pupillary response, and the injury severity score (ISS). A significant increased risk of death was also found for patients with a midline shift of over 15 mm. Conclusions The present study predicts a strong correlation between respiratory failure, pathological pupillary response, a higher ISS, and substantial midline shift with poor outcomes in elderly patients sustaining an isolated severe TBI. Trial registration Clinical trials: ID: NCT02386865. Registered 12 March 2015—retrospectively registered.
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spelling doaj.art-96d0a96b312a46de9928c3cf5940a8922022-12-22T04:19:55ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2018-11-011311610.1186/s13018-018-0975-yRisk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injuryRoman C. Ostermann0Julian Joestl1Thomas M. Tiefenboeck2Nikolaus Lang3Patrick Platzer4Marcus Hofbauer5Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of ViennaDepartment of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of ViennaDepartment of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of ViennaDepartment of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of ViennaDepartment of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of ViennaDepartment of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of ViennaAbstract Background Traumatic brain injury (TBI), particularly in the elderly patient population, is known to be the single largest cause of death and disability worldwide. The purpose of this retrospective study was to evaluate clinical factors predicting poor outcome with special emphasis on the impact of respiratory failure (RF) on mortality in elderly patients with isolated severe TBI. Methods All elderly patients (age ≥ 65 years) with isolated severe head injury, admitted to this level I trauma center, during a period of 18 years (from January 1992 to December 2010) were identified from the trauma registry. The medical records were reviewed for demographics, mechanism of injury (MOI), GCS score at admission, RF, pupillary light reflex (LR), CT findings (subdural hematoma, subarachnoid hematoma, edema, midline-shift), and whether there was conservative treatment or surgical intervention and the Glasgow Outcome Score (GOS) at hospital discharge. Stepwise logistic regression analysis was used to identify risk factors for a poor prognosis and outcome. Results The following variables influenced the mortality: respiratory failure, pupillary response, and the injury severity score (ISS). A significant increased risk of death was also found for patients with a midline shift of over 15 mm. Conclusions The present study predicts a strong correlation between respiratory failure, pathological pupillary response, a higher ISS, and substantial midline shift with poor outcomes in elderly patients sustaining an isolated severe TBI. Trial registration Clinical trials: ID: NCT02386865. Registered 12 March 2015—retrospectively registered.http://link.springer.com/article/10.1186/s13018-018-0975-yElderly patientsIsolated severe traumatic brain injuries (TBI)Respiratory failureOutcome prediction
spellingShingle Roman C. Ostermann
Julian Joestl
Thomas M. Tiefenboeck
Nikolaus Lang
Patrick Platzer
Marcus Hofbauer
Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury
Journal of Orthopaedic Surgery and Research
Elderly patients
Isolated severe traumatic brain injuries (TBI)
Respiratory failure
Outcome prediction
title Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury
title_full Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury
title_fullStr Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury
title_full_unstemmed Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury
title_short Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury
title_sort risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury
topic Elderly patients
Isolated severe traumatic brain injuries (TBI)
Respiratory failure
Outcome prediction
url http://link.springer.com/article/10.1186/s13018-018-0975-y
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