-Original-

Treatment of Geriatric Traumatic Brain Injury: A Nationwide Cohort Study

Shoji Yokobori, Ken Saito, Kazuma Sasaki, Takahiro Kanaya, Yu Fujiki, Masahiro Yamaguchi, Shin Satoh, Akihiro Watanabe, Yutaka Igarashi, Go Suzuki, Junya Kaneko, Ryuta Nakae, Hidetaka Onda, Saori Ishinokami, Yasuhiro Takayama, Yasutaka Naoe, Hidetaka Sato, Kyoko Unemoto, Akira Fuse and Hiroyuki Yokota

Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan

Background: Because of the aging of the Japanese population, traumatic brain injuries (TBI) have increased in elderly adults. However, the effectiveness and prognosis of intensive treatment for geriatric TBI have not yet been determined. Thus, we used nationwide data from the Japan Neurotrauma Data Bank (JNTDB) projects to analyze prognostic factors for intensive and aggressive treatments.
Methods: We analyzed 1,879 geriatric TBI cases (age ≥65 years) registered in four JNTDB projects: Project 1998 (P1998) to Project 2015 (P2015). Clinical features, use of aggressive treatment, and 6-month outcomes on the Glasgow Outcome Scale (GOS) were compared among study projects. Logistic regression was used to identify prognostic factors in aggressively treated patients.
Results: The percentage of geriatric TBI cases significantly increased with time-P1998: 30.1%; Project 2004 (P2004): 34.6%; Project 2009 (P2009): 43.9%; P2015: 53.6%, p<0.0001). Use of aggressive treatment also significantly increased, from 67.0% in P1998 to 69.3% in P2015 (p<0.0001). Less invasive methods, such as trepanation and normothermic targeted temperature management, were more often chosen for geriatric patients. These efforts resulted in a significant decrease in the 6-month mortality rate, from 76.2% in P1998 to 63.1% in P2015 (p=0.0003), although the percentage of severely disabled patients increased, from 8.9% in P1998 to 11.1% in P2015 (p=0.0003). Intraventricular hemorrhage was the factor most strongly associated with unfavorable 6-month outcomes (OR 3.79, 95% CI 1.78-8.06, p<0.0001).
Conclusions: Less invasive treatments reduced mortality in geriatric TBI but did not improve functional outcomes. Patient age was not the strongest prognostic factor; thus, physicians should consider characteristics other than age.

J Nippon Med Sch 2021; 88: 194-203

Keywords
traumatic brain injury, Glasgow Outcome Scale, intraventricular hemorrhage, intracranial pressure

Correspondence to
Shoji Yokobori, MD, PhD, Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
shoji@nms.ac.jp

Received, March 14, 2020
Accepted, May 25, 2020