Treatment outcome in elderly traumatic brain injury patients at a Level 2 trauma care facility in a low-middle income country.

Abstract

A slower recovery and worse clinical outcome seen in elderly patients with TBI have made it a matter of concern. The medical literature is replete with studies on the outcomes of elderly TBI patients managed at Level 1 and Level 2 trauma centers in developed countries. However, the healthcare services in lower-middle-income countries are far from an ideal scenario, and hence the outcome will naturally be different. To bridge this knowledge gap, we retrospectively analyzed the medical records of all the elderly TBI patients admitted to a Level 2 trauma center over three consecutive years. In contrast to the existing medical literature, the most common mode of injury was road traffic accidents (63%), followed by falls (47%). On subgroup analysis, 60-70 years age group constituted the maximum proportion of cases (n = 82, 68.33%), had the highest proportion of severe TBI (n = 57, 69.5%) and in-hospital deaths within 48 hours of hospital admission (n = 7, 18.92%). The overall in-hospital mortality of 42.5% (n = 51) was lower compared to earlier studies, but the proportion of patients with poor outcomes was 85% (n = 102). In multivariate analysis lower GCS at admission, specifically a lower motor score, had a statistically significant association with poor outcomes. The injury profile and outcome of elderly TBI patients in a low-middle-income nation are markedly different, and the resources should be tailored accordingly, with a greater attention to strengthening home care services and conditioning programs.