Continuation of poor surgical outcome after elderly brain injury.

Background: In spite of the decline in mortality among trauma patients, with advanced trauma care, the outcome for elderly patients remains poor. Both operative and nonoperative outcome for elderly patients after head trauma has resisted improvement.

Methods: Forty-five consecutive patients 70 years or older were included in the study. All these patients were admitted from January 2000 to June 2005. Road-traffic accidents caused most of the head injuries.

Results: Most of the patients (n = 33) belonged to severe head injury category. Contusions were the commonest CT scan finding (n = 27), for which surgery was indicated. Unexplained clinical deterioration, in spite of timely surgery and satisfactory postoperative CT scans, in a significant number of patients (n = 29) was noteworthy. Over the same period, the comparative group of younger patients (20-40 years, n = 1026) was also analyzed.

Conclusion: Elderly patients experienced higher mortality and poorer functional outcome. The natural history of traumatized brain among elderly patients remains unchanged till the present times. The nihilistic scenario asks for reevaluation of interventions, relook into the neurobiology of aging brain, and aggressive research for remedial measures for such patients, especially among severe head injury group.