Treatment Outcome in Elderly Traumatic Brain Injury Patients at a Level 2 Trauma Care Facility in a Low-Middle-Income Country

OBJECTIVE: Slower recovery and worse clinical outcome seen in elderly patients with TBI have made it a matter of concern. 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 low-middle-income countries are far from an ideal scenario, and hence, the outcome will naturally be different. METHODS: 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 3 consecutive years. RESULTS: 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%) and 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. CONCLUSION: 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.

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