A Prospective Study of Traumatic Brain Injury in Geriatric Patients

Introduction and background: The percentage of senior citizens in India has been growing at an increasing rate in recent years and the trend is likely to continue. Traumatic Brain Injury (TBI) still remains a major cause of morbidity and mortality. In developing countries like India where motorized travel is quickly growing without accompanying safety precautions and adherence to traffic rules and regulations, road traffic accidents are more frequent leading to increase in traumatic brain injuries. Elderly patients sustaining TBI have higher morbidity and mortality and prolonged recovery trajectories than younger patients. The current “One size fits all” approach to traumatic brain injury management of adult patients neglects special issues of elderly population. Aims: Aim of the study is to analyze demographic data, clinico-radiological features, co-morbid illness of elderly patients with traumatic brain injuries treated either with surgical or conservative management, to evaluate the risk factors predicting poor prognosis among elderly TBI patients, to study the outcome and mortality among elderly (65-75) and very elderly ( >75 years) age groups and to study the validation of eTBI (Elderly Traumatic Brain Injury) score in predicting mortality. Methodology: This is a prospective single center study conducted at the Institute of Neurosurgery, Madras Medical College, Chennai, Tamilnadu, India. We enrolled 200 patients of ≥ 65 years of age with Traumatic brain Injury between May 2021 and October 2021. Information about patients, demographic data, clinical and radiological features, co-morbid conditions, in-hospital course of treatment and associated complications as well as outcome was recorded. The collected data were analyzed with IBM-SPSS statistics software 23.0 Version. To find the significance in categorical data Chi-Square test was used. The probability value .05 is considered as significant level. Results: Mean age among the patients is 70.16 and maximum age enrolled in this study is 88. 144 were males and 38 were females. There were 91 patients with mild injury (50%), 68 patients with moderate injury (37.4%) and 23 patients with severe injury (12.6%). About 127 (69.8%) patients had favorable outcome and 55 (30.2%) patients had unfavorable outcome. Road traffic accidents accounted for most injuries (n=100) followed by ground level falls (n = 74) with other causes accounting for very few numbers. Most common associated comorbidity found was systemic hypertension which was seen in 34.1% followed by diabetes in 25.3%. Statistical analysis showed poor GCS score at admission, absent/effaced basal cisterns and/or presence of midline shift in CT, presence of co-morbidities like diabetes, hypertension and CAD, preinjury intake of antiplatelets or anticoagulants or beta blockers were all associated with unfavorable outcome. Lower eTBI scores were associated with unfavorable outcome. Prolonged ICU stay and prolonged mechanical ventilation both of which was found to adversely affect the clinical outcome in our study.