Geriatric Traumatic Brain Injury: An Attempt to Predict Outcome Using a Nomogram

Background and objectives: With improving life expectancy, the proportion of geriatric patients is steadily increasing in the population and traumatic brain injury (TBI) in the elderly is becoming a problem demanding increasing attention from the health community. We attempted to identify factors that correlate with the outcome (as measured by the Glasgow Outcome Scale [GOS]) in elderly patients with TBI and make a prognostic model.

Materials and methods: A prospective analysis of 220 consecutive TBI patients aged ≥60 years admitted at our hospital was performed. Data about demography, comorbidities, mode of injury, clinico-radiological features, associated injuries, medical/surgical complications, and outcome was analyzed. Patients without imaging findings of TBI and patients with chronic subdural hematoma (SDH) and lesional intracranial hemorrhage were excluded.

Results: The mean age of patients was 69.17 years, with 70.9% being males. Motor vehicle accidents (44%) and ground-level falls (43.7%) were the most common modes of injury. Antiplatelets and anticoagulants were being taken by 14.6% and 1.8% of patients, respectively. Out of 220 patients, 124 patients had mild, 48 had moderate, and 48 had severe head injuries. Median Rotterdam score (RS) was 2. Forty-one patients underwent surgery. The outcome was favorable (GOS 4-5) in 54.1% and unfavorable (GOS 1-3) in 45.9% of patients, with the overall mortality at the end of 1 month being 30.9%. On multivariate regression analysis, Glasgow Coma Scale (GCS), RS, and coagulation abnormality were found to be independent prognostic factors; these three variables were then used to design a nomogram.

Conclusion: In the absence of specific geriatric TBI prognostic models, a nomogram using GCS, RS, and coagulation abnormality can be used as a prognostic model.