Traumatic brain injury in elderly patients

Sammanfattning: The increase of elderly traumatic brain injury (TBI) patients constitutes a considerable challenge. The aim was therefore to specifically study elderly TBI patients with respect to patient characteristics, neurointensive care (NIC) and outcome, and to identify age specific features, which may be important for selection of patients and optimization of NIC in the elderly. Data from the Uppsala TBI-registry and collected physiological monitoring data from the NIC unit were analysed.Between 1996–1997 and 2008–2009, patients ≥60 years had doubled from 16% to 30%. Despite the increase of elderly an overall favorable outcome was maintained at around 75% between the two periods and the elderly showed favorable outcome in slightly more than 50%.Analysis of characteristics and outcome between 2008–2010 showed that fall accidents and acute subdural hematoma were more common in the elderly ≥65 years. Admission status and NIC treatment did not differ depending on age, except that a larger proportion of the elderly had surgery. Elderly ≥65 years showed a favorable outcome in 51% compared to 72% in the young.Studies of patients ≥60 years treated 2008–2014 showed that high age, multiple injuries, low Glasgow coma motor score on admission and the use of mechanical ventilation were negative prognostic factors.Elderly had different secondary insult patterns with a higher percentage of good monitoring time (%GMT) with high cerebral perfusion pressure (CPP), high mean arteria blood pressure (MAP) and high systolic blood pressure (SBP) and less %GMT with high intracranial pressure (ICP), low CPP and low MAP. On the contrary to the young, high %GMT with SBP>180 was associated with favorable outcome in the elderly, indicating that blood pressure probably should be treated differently in the elderly.Elderly had worse pressure autoregulation (higher values of PRx) and spent longer time with higher PRx. Elderly also had higher optimal CPP and spent lower %GMT with CPP close to optimal CPP. High PRx correlated with mortality in elderly but pressure autoregulation influenced outcome less in the elderly.Overall, the results show that elderly TBI patients differ in many aspects and more studies are warranted to increase knowledge and optimize NIC.