背景:由于人口老龄化的增加,老年人的创伤性脑损伤(TBI)引起了全球重大的健康问题。
方法:我们搜索了PubMed,科克伦图书馆,和Embase从数据库开始到2024年2月1日。在住院环境中进行的研究报告了患有TBI的老年人(≥60岁)的住院死亡率和/或确定预测此类结局的风险因素,包括在内。数据是从发表的报告中提取的,住院死亡率作为我们的主要结果是以比率的形式合成的,并以比值比的形式合成了预测院内死亡率的危险因素.亚组分析,我们的分析使用了荟萃回归和剂量-反应荟萃分析.
结果:我们纳入了105项研究,涵盖来自30个国家/地区的2,217,964名患者。在70项研究中,老年TBI患者的总体住院死亡率为16%(95%CI15%-17%)。住院死亡率为5%(95%CI,3%-7%),18%(95%CI,12%-24%),轻度为65%(95%CI,59%-70%),来自10、7和23项研究的中度和重度亚组,分别。在总体(1981-2022年)和重度(1986-2022年)患有TBI的老年患者中,观察到了多年来住院死亡率的下降。老年人1.69(95%CI,1.58~1.82,P<0.001),男性1.34(95%CI,1.25至1.42,P<0.001),临床状况,包括交通相关的伤害原因1.22(95%CI,1.02至1.45,P=0.029),GCS中等(GCS9-12与GCS13-15相比)4.33(95%CI,3.13至5.99,P<0.001),GCS严重(GCS3-8与GCS13-15相比)23.09(95%CI,13.80至38.63,P<0.001),瞳孔光反射异常3.22(95%CI,2.09~4.96,P<0.001),损伤后低血压2.88(95%CI,1.06~7.81,P=0.038),多发性创伤2.31(95%CI,2.03至2.62,P<0.001),手术干预2.21(95%CI,1.22至4.01,P=0.009),伤前健康状况,包括伤前共病1.52(95%CI,1.24至1.86,P=0.0020),伤前抗血栓治疗1.51(95%CI,1.23~1.84,P<0.001)与老年TBI患者院内死亡率较高相关。根据抗血栓药物的多种类型进行亚组分析,至少两项纳入研究显示抗凝治疗1.70(95%CI,1.04至2.76,P=0.032),华法林2.26(95%CI,2.05~2.51,P<0.001),DOACs1.99(95%CI,1.43~2.76,P<0.001)与死亡率升高相关。年龄的剂量-反应荟萃分析发现,每增加1年的住院死亡率,比值比为1.029(95%CI,1.024至1.034,P<0.001)。
结论:在老年TBI患者领域,总体住院死亡率及其时空特征,根据损伤严重程度的亚组住院死亡率,首先对年龄的剂量-反应荟萃分析进行全面总结。重大关键风险因素,包括以前没有阐明的,已确定。因此,我们的研究有助于强调治疗老年人TBI的重要性,为医疗保健提供者提供有用的信息,并启动未来的管理指南。这项工作强调了将老年人TBI治疗和管理纳入更广泛的健康战略的必要性,以应对全球人口老龄化带来的挑战。
背景:PROSPEROCRD4202223231.
BACKGROUND: Traumatic brain injury (TBI) among elderly individuals poses a significant global health concern due to the increasing ageing population.
METHODS: We searched PubMed, Cochrane Library, and Embase from database inception to Feb 1, 2024. Studies performed in inpatient settings reporting in-hospital mortality of elderly people (≥60 years) with TBI and/or identifying risk factors predictive of such outcomes, were included. Data were extracted from published reports, in-hospital mortality as our main outcome was synthesized in the form of rates, and risk factors predicting in-hospital mortality was synthesized in the form of odds ratios. Subgroup analyses, meta-regression and dose-response meta-analysis were used in our analyses.
RESULTS: We included 105 studies covering 2217,964 patients from 30 countries/regions. The overall in-hospital mortality of elderly patients with TBI was 16 % (95 % CI 15 %-17 %) from 70 studies. In-hospital mortality was 5 % (95 % CI, 3 %-7 %), 18 % (95 % CI, 12 %-24 %), 65 % (95 % CI, 59 %-70 %) for mild, moderate and severe subgroups from 10, 7, and 23 studies, respectively. A decrease in in-hospital mortality over years was observed in overall (1981-2022) and in severe (1986-2022) elderly patients with TBI. Older age 1.69 (95 % CI, 1.58-1.82, P < 0.001), male gender 1.34 (95 % CI, 1.25-1.42, P < 0.001), clinical conditions including traffic-related cause of injury 1.22 (95 % CI, 1.02-1.45, P = 0.029), GCS moderate (GCS 9-12 compared to GCS 13-15) 4.33 (95 % CI, 3.13-5.99, P < 0.001), GCS severe (GCS 3-8 compared to GCS 13-15) 23.09 (95 % CI, 13.80-38.63, P < 0.001), abnormal pupillary light reflex 3.22 (95 % CI, 2.09-4.96, P < 0.001), hypotension after injury 2.88 (95 % CI, 1.06-7.81, P = 0.038), polytrauma 2.31 (95 % CI, 2.03-2.62, P < 0.001), surgical intervention 2.21 (95 % CI, 1.22-4.01, P = 0.009), pre-injury health conditions including pre-injury comorbidity 1.52 (95 % CI, 1.24-1.86, P = 0.0020), and pre-injury anti-thrombotic therapy 1.51 (95 % CI, 1.23-1.84, P < 0.001) were related to higher in-hospital mortality in elderly patients with TBI. Subgroup analyses according to multiple types of anti-thrombotic drugs with at least two included studies showed that anticoagulant therapy 1.70 (95 % CI, 1.04-2.76, P = 0.032), Warfarin 2.26 (95 % CI, 2.05-2.51, P < 0.001), DOACs 1.99 (95 % CI, 1.43-2.76, P < 0.001) were related to elevated mortality. Dose-response meta-analysis of age found an odds ratio of 1.029 (95 % CI, 1.024-1.034, P < 0.001) for every 1-year increase in age on in-hospital mortality.
CONCLUSIONS: In the field of elderly patients with TBI, the overall in-hospital mortality and its temporal-spatial feature, the subgroup in-hospital mortalities according to injury severity, and dose-response meta-analysis of age were firstly comprehensively summarized. Substantial key risk factors, including the ones previously not elucidated, were identified. Our study is thus of help in underlining the importance of treating elderly TBI, providing useful information for healthcare providers, and initiating future management guidelines. This work underscores the necessity of integrating elderly TBI treatment and management into broader health strategies to address the challenges posed by the aging global population.
BACKGROUND: PROSPERO CRD42022323231.