Risk factors related to in-hospital mortality in elderly patients with traumatic brain injury / 中华创伤杂志

ABSTRACT

Objective:To investigate the risk factors of in-hospital mortality in elderly patients with traumatic brain injury (TBI).Methods:A case control study was conducted on 709 elderly patients with TBI admitted to Luhe Hospital, Capital Medical University from January 2012 to October 2018, including 468 males and 241 females; aged 60-97 years [(70.4±8.5)years]. Patients were divided into death group ( n=82) and survival group ( n=627) based on death or not during hospitalization. Data of the two groups were documented, including gender, age, causes of injury (traffic accident injury, fall injury, assault injury or others), history of comorbidities (hypertension, coronary heart disease, diabetes or coronary heart disease), Glasgow coma score (GCS) on admission, operation modalities (trepanation and drainage, hematoma evacuation, decompressive craniectomy or intracranial pressure monitoring), complications (pneumonia, stress ulcer, electrolyte imbalance, hypoproteinemia or secondary epilepsy) and length of hospitalization. Univariate analysis was used to analyze the correlation between the above factors and in-hospital mortality in elderly patients with TBI. Multivariate Logistic regression analysis was used to determine the independent risk factors for their in-hospital mortality. Results:Univariate analysis showed that sex, causes of injury, hypertension, cerebral infarction, diabetes, GCS on admission, hematoma evacuation, decompressive craniectomy, intracranial pressure monitoring, pneumonia, stress ulcer and length of hospital stay were correlated with in-hospital mortality in elderly patients with TBI ( P<0.05 or 0.01), while there was no correlation with age, history of coronary heart disease, trepanation and drainage, electrolyte imbalance, hypoproteinemia and secondary epilepsy (all P>0.05). Multivariate Logistic regression analysis showed that fall injury ( OR=0.28, 95% CI 0.08-0.96, P<0.05), hypertension ( OR=0.29, 95% CI 0.10-0.84, P<0.05),GCS of 9-12 points on admission ( OR=12.98, 95% CI 4.70-35.84, P<0.01), GCS of 3-8 points on admission ( OR=33.67, 95% CI 14.01-80.93, P<0.01) and length of hospital stay<11 days ( OR=0.06, 95% CI 0.02-0.13, P<0.01) were significantly associated with their in-hospital mortality. Conclusions:Fall injury, hypertension, GCS≤12 points on admission and length of hospital stay <11 days are independent risk factors for in-hospital mortality in elderly patients with TBI, especially that patients with GCS of 3-8 points on admission have higher in-hospital modality than patients with GCS≥ 9 points, indicating the importance of above independent risk factors in evaluating outcome.