Traumatic Brain Injury In The Elderly Population: A 20-Year Experience In A Single Neurosurgery Centre In Kwazulu Natal.

Abstract

Background: Traumatic Brain Injury (TBI) in the elderly is associated with high mortality and morbidity. In low-middle income countries (LMIC) there is paucity of research directed towards management of TBI in the elderly. Aim: A retrospective review of medical records of elderly patients (age 65 years and above) with a diagnosis of TBI managed between January 2003 to July 2022. Results: A total of 169 patients were enrolled in the study. The mean age was 71 (6.1) years. There were 70% males and the (M:F) ratio was (2.1:1). The mechanism of injuries included falls (39.6%), interpersonal violence (30%  ) and road traffic crashes ( 17%) and unknown ( 11.3). The admission Glascow Coma Scale (GCS) were 13-15( 33.7%), 9 – and 3-8 (24.8%). The associated co-morbidities include Hypertension (57%) and Diabetes Mellitus (5%). Neuroradiological findings included Acute Subdural Hematoma(50%), intracerebral haematoma (20%) Acute Extradural Haematoma (15%), depressed skull fracture (15%). Surgical management was undertaken in 72% of patients. Complications included pneumonia (19,6%) wound sepsis (2%), meningitis (1%), septicaemia (1%), post traumatic Hydrocephalus (0,9%) and deep venous thrombosis (0,9%). The mean ICU stay was 11 (9,1) days. The hospital mortality rate was 31%. Conclusion: TBI in the elderly is less studied in the LMIC and is associated with a high mortality rate. Acute Subdural haematomas are the commonest intracranial pathology. More resources should be directed towards further research in TBI in the elderly in LMIC.