gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Operative neurosurgical treatment of isolated traumatic brain injury in patients ≥80 years of age – Who might benefit?

Operative Behandlung des isolierten Schädel-Hirn-Traumas bei ≥ 80jährigen Patienten – Wer profitiert?

Meeting Abstract

  • presenting/speaker Patrick Czorlich - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Marius Mader - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Pedram Emami - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Rolf Lefering - Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin (IFOM), Köln, Deutschland
  • Michael Hoffmann - Schön Klinik Neustadt, Klinik für Orthopädie und Unfallchirurgie, Neustadt, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP211

doi: 10.3205/19dgnc546, urn:nbn:de:0183-19dgnc5469

Published: May 8, 2019

© 2019 Czorlich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Traumatic Brain Injuries (TBI) in older adults is an increasing issue in modern medicine. Nevertheless, it remains unclear which patients presenting with TBI and 80 years of age or older benefit from an aggressive surgical treatment. Aim of this study was to explore the effect of an aggressive surgical treatment in isolated TBI patients ≥ 80 years of age.

Methods: Data were driven from the TraumaRegister DGU® from 2002–2016. Inclusion criteria were ≥80 years of age, an Abbreviated Injury Scale Head (AIS) ≥3, an AIS Non-Head ≤1. Patients with incomplete datasets or transferred patients were excluded. The cohort was distinguished in conservatively and surgically treated patients and outcome was assessed at discharge using the Glasgow Outcome Scale (GOS). A favorable outcome was defined as a GOS of 4 and 5. Multivariate regression analysis and standardized mortality ratios were applied.

Results: A total of 1.693 patients (431 surgically and 1262 conservatively treated patients) were analyzed. Mortality rate was 54.4% (687 patients) in the conservative group and 49.4% in the surgical group. Simultaneously, there were more patients discharged with an GOS 2 (persistent vegetative state) in the surgical group (7.9%, 34 patients) than in the conservative group (1.0%, 13 patients). Male gender (p<0.001), Glasgow Coma Scale (GCS) of 9–14 (p=0.001), GCS of 3–8 (p<0.001), traumatic subarachnoid hemorrhage (p=0.042), intracerebral hemorrhage (p=0.03), a cerebral edema (p<0.001), brainstem laceration (p=0.007), coagulopathy (p<0.001), fixed pupils (p=0.001), initial intubation (p=0.02) and AIS Head of 5/6 (p<0.001) were associated with a lower chance for favorable outcome at discharge. A subgroup analysis in the surgically treated group showed an association between a higher mortality risk and brainstem laceration (Odds Ratio (OR) 9.70 95% confidence interval (CI) [1.15–81.5] p=0.04), fixed pupils (OR 5.30 95% CI [2.00–14.0] p=0.001), initial intubation (OR 2.05 95% CI [1.08–3.88] p=0.03) and AIS Head of 5/6 (OR 1.83 95% CI [1.06–3.18] p=0.03)

Conclusion: Patients 80 years of age or older seem to benefit from an aggressive operative treatment regarding mortality rate. However, there has been a higher rate of a poor neurological outcome particularly with regards to persistent vegetative state in the surgical treatment group at discharge. Clinical decision-making remains challenging in these vulnerable patients and should be based on a case-by-case evaluation.