Wednesday, September 17, 2008
Outcome in severe head injuries in the elderly
ANZ Journal of Surgery has a study looking at outcomes in severely head injured older adults. It's a retrospective case series looking at the hospital course and outcomes for 96 head injured older patients - using data from a statewide trauma registry database in Victoria, Australia. Patients were older than 65 years and had a Glasgow Coma Scale score of 8 or less as measured by paramedics on the scene. The study provides some general, ball-park level prognostic data. It's not good, of course. In-hospital mortality was 70%. Mortality for those over 85 years was 100%, and notably 73% of those patients were managed 'palliatively' only (that's as assumption they worked in using the registry data - if the patients had no surgeries and weren't admitted to an ICU they were assumed to have palliative-only management which is probably true for most of those patients given their GCS.) GCS was not associated with mortality in these patients; nor was it associated with a decision for 'palliative' treatment - that seemed to be based more on age.
