A meta-analysis of functional outcome among older adults with traumatic brain injury

Issue title: TBI and Aging

Guest editors: Wayne A. Gordon

Article type: Review Article

Authors: McIntyre, Amanda^a | Mehta, Swati^a | Janzen, Shannon^a | Aubut, JoAnne^a | Teasell, Robert W.^{a; b; *}

Affiliations: [a] Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, ON, Canada | [b] Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON, Canada

Correspondence: [*] Address for correspondence: Robert W. Teasell, MD, FRCPC, Department of Physical Medicine and Rehabilitation, Parkwood Hospital, Hobbins Building, Suite 404, 801 Commissioners Road E., London, ON, N6C 5J1, Canada. Tel.: +1 519 685 4000, Ext. 44559; E-mail: Robert.Teasell@sjhc.london.on.ca

Abstract: Objective:The objective of this study was to determine rates of functional outcomes, based on Glasgow Outcome Scale scores, among older adults (>60 years) after a traumatic brain injury. Methods:An extensive database search was conducted. To be included all articles were published in English, included individuals 60 years or older, explicitly stated in-hospital GCS scores and GOS scores within one year post-TBI. Data was pooled on patient characteristics, mortality rates, time to death, and study design. Results:A total of 11 studies were included in this review. Among individuals with severe TBI, favourable, unfavourable, and fatal outcomes were observed in 7.9% (CI 5.3%–11.8%), 13.8% (CI 10.0%–18.8%) and 79.3% (CI 73.2%–84.4%), respectively. Among those with moderate TBI, favourable, unfavourable, and fatal outcomes were observed in 32.2% (CI 18.0%–50.7%), 29.5% (CI 16.5%–47.0%), and 42.5% (CI 26.1%–60.7%), respectively. Among those with mild TBI, favourable, unfavourable, and fatal outcomes were observed in 80.5% (CI 53.2%–93.7%), 7.0% (CI 1.9%–22.7%), and 10.7% (CI 3.1%–30.9%), respectively. Conclusion:This study has demonstrated the significant interaction between GCS and GOS among older adults. Although older adults may require aggressive and comprehensive treatment to achieve these favourable outcomes, high rates of unfavourable outcome should not justify the use of conservative treatment.

Keywords: Aging, traumatic brain injury, Glasgow coma scale, Glasgow outcome scale

DOI: 10.3233/NRE-130862

Journal: NeuroRehabilitation, vol. 32, no. 2, pp. 409-414, 2013