■全球,许多社会正在经历老年人数量的增加(>65岁)。然而,老年人的年龄和生物学年龄之间的差距一直在扩大,这趋势是社会中更加活跃和参与社会的一部分。同时,创伤性脑损伤(TBI)的发病率在全球范围内呈上升趋势.这项研究的目的是调查与年轻患者相比,老年人TBI和去骨瓣减压术(DC)后的结果。
■回顾,多中心,描述性,描述性进行了观察性研究,包括2005年至2022年间接受DC治疗的严重TBI患者。根据格拉斯哥结果量表(基于三个预后带的滑动二分法)评估出院后和12个月的结果。显著性确定为p≤0.05。
■共纳入223例患者。大多数(N=158,70.9%)在放电时存活于TBI和DC。然而,不良结局在出院时(88%)和12个月后(67%)占优势.在出院时(p=0.006)和12个月时(p<0.001)的年龄组之间,对年轻患者(≤65岁)的支持存在差异。老年患者的亚组分析(66至≤74与≥75年)没有发现任何显著差异。12个月后,64%的老年患者有致命的结局。在65岁以上的人群中,只有10%的人有好的或非常好的结果。25%依赖于日常活动的支持。12个月后,年龄(OR0.937,p=0.007,CI95%:0.894-0.981;单变量)和颅骨修补术(单变量和多变量结果)是二分化GOS的影响因素.对于12个月后的不利结果,阈值计算为年龄=55.5岁(p<0.001),创伤和手术之间的时间=8.25h(p=0.671),格拉斯哥昏迷评分(GCS)=4(p=0.429)。
■即使在当前的神经重症监护的现代条件下,随着重症监护和康复医学的重大进展,大多数>65岁的重度TBI和DC患者死亡或有依赖性,通常需要广泛的支持.在决策和咨询过程中也应考虑到这一方面(中间,学科内或与亲戚一起)对于一个非常流动和活跃的老年社会阶层,连同病人的遗嘱。
UNASSIGNED: Globally, many societies are experiencing an increase in the number of older adults (>65 years). However, there has been a widening gap between the chronological and biological age of older adults which trend to a more active and social participating part of the society. Concurrently, the incidence of traumatic brain injury (TBI) is increasing globally. The aim of this study was to investigate the outcome after TBI and decompressive craniectomy (DC) in older adults compared with younger patients.
UNASSIGNED: A retrospective, multi-centre, descriptive, observational study was conducted, including severe TBI patients who were treated with DC between 2005 and 2022. Outcome after discharge and 12 months was evaluated according to the Glasgow Outcome Scale (Sliding dichotomy based on three prognostic bands). Significance was established as p ≤ 0.05.
UNASSIGNED: A total of 223 patients were included. The majority (N = 158, 70.9%) survived TBI and DC at discharge. However, unfavourable outcome was predominant at discharge (88%) and after 12 months (67%). There was a difference in favour of younger patients (≤65 years) between the age groups at discharge (p = 0.006) and at 12 months (p < 0.001). A subgroup analysis of the older patients (66 to ≤74 vs. ≥75 years) did not reveal any significant differences. After 12 months, 64% of the older patients had a fatal outcome. Only 10% of those >65 years old had a good or very good outcome. 25% were depending on support in everyday activities. After 12 months, the age (OR 0.937, p = 0.007, CI 95%: 0.894-0.981; univariate) and performed cranioplasty (univariate and multivariate results) were influential factors for the dichotomized GOS. For unfavourable outcome after 12 months, the thresholds were calculated for age = 55.5 years (p < 0.001), time between trauma and surgery = 8.25 h (p = 0.671) and Glasgow Coma Scale (GCS) = 4 (p = 0.429).
UNASSIGNED: Even under the current modern conditions of neuro-critical care, with significant advances in intensive care and rehabilitation medicine, the majority of patients >65 years of age following severe TBI and DC died or were dependent and usually required extensive support. This aspect should also be taken into account during decision making and counselling (inter-, intradisciplinary or with relatives) for a very mobile and active older section of society, together with the patient\'s will.