Survival after severe brain injury in the aged
J. L. Pennings, B. L. Bachulis, C. T. Simons and T. Slazinski
Department of Surgery, Emanuel Hospital and Health Center, Portland, Ore.
OBJECTIVE: We studied the impact of age on outcomes for patients with
severe blunt brain injury. DESIGN: Inception cohort, retrospective study,
cost-benefit analysis. SETTING: Level 1 trauma center. PATIENTS: Ninety
consecutive patients aged 60 years or older were compared with 79 randomly
selected patients aged 20 to 40 years, all with Glasgow Coma Scale scores
of 5 or less. These patients were admitted from January 1, 1983, to
September 1, 1991. Patients who died less than 6 hours after admission to
the hospital, had cranial gunshot wounds, or had no structural brain injury
on computed tomographic scans were excluded, leaving 42 elderly and 50
younger patients for the final analysis. MAIN OUTCOME MEASURES: Mortality
rates and quality of survival as measured by the Glasgow Outcome Scale
scores. RESULTS: There were no differences between the older and younger
patients in admission Glasgow Coma Scale score, Revised Trauma Score,
Injury Severity Score, or Abbreviated Injury Scale 1 score. Resuscitation,
neurosurgical interventions, and adequacy of nutritional support were
equivalent. Elderly patients had a higher incidence of brain confusion and
more frequently had multiple brain lesions. Thirty-three (79%) of the 42
elderly patients died in the hospital. Death was attributed to secondary
organ failure in 33% of these elderly patients. In-hospital mortality was
36% for younger patients, all of whom died of brain injury. On the basis of
the Glasgow Outcome Scale, only one elderly survivor made a favorable
recovery (2%) compared with 38% of young patients. Total charges per
favorable outcome were $1,540,971 for the elderly compared with $154,155
for the young. CONCLUSIONS: Elderly patients experienced higher mortality,
had poorer functional recovery, more frequently died of secondary organ
failure, and consumed more resources per favorable outcome than did younger
patients with similar injury profiles despite equivalent treatment efforts.
