Survival After Severe Brain Injury in the Aged

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.