Early surgical decompression results in favorable outcomes in elderly patients with severe traumatic brain injury

A BSTRACT Objectives: This study aimed to assess the impact of distinct treatment modalities on outcomes in patients with moderate-to-severe traumatic brain injury (TBI). Materials and Methods: This retrospective single-center study analyzed 228 patients with moderate-to-severe TBI (Glasgow Coma Scale [GCS] 3–12) admitted to Hualien Tzu Chi Hospital from 2017 to 2019. Patients were grouped by age (<65 or ≥65) and GCS (3–8 or 9–12). Four treatment strategies were assessed: decompressive craniectomy (DC), craniotomy, intracranial pressure (ICP) monitoring alone, and conservative management. Outcomes included hospital length of stay (LOS), ICU duration, and mortality. Statistical analyses included Kaplan–Meier survival curves, Log-rank tests, Gehan–Breslow Wilcoxon tests, and Kruskal–Wallis tests. Results: In Group 1 ( n = 58, <65, GCS: 9–12), DC was associated with the longest median hospital (43.0 days) and ICU stay (7.0 days). In Group 2 ( n = 44, ≥65, GCS: 9–12), significant differences in ICU stay ( P < 0.05) were observed. In Group 3 ( n = 77, <65, GCS 3–8), ICP monitoring alone resulted in the longest hospital LOS (33.5 days), whereas DC was associated with the longest ICU stay (13 days). In Group 4 (≥65 years, GCS: 3–8, n = 49), DC correlated with the longest hospital LOS (39.0 days) and ICU stay (10.0 days). In severe TBI patients, the ICP monitoring group displayed better survival over time. Moreover, DC and ICP monitoring only achieved the lowest mortality rates (25%) in Group 4. Conclusion: Early DC and ICP monitoring substantially improve survival and aggravation in elderly patients with severe TBI, underscoring their critical role in outcome optimization.