A new study from the Helsinki Hospital Department of Neurosurgery suggests all hope is not lost for people over 75 who experience severe traumatic brain injury.
It has become widely accepted that elderly patients with TBI-related acute subdural hematoma have little chance of surviving surgical intervention and even lower chances of recovering to an independent life. However, the new research suggests that even patients over 75 can recover from a severe TBI under the right conditions.
Age is one of the strongest indicators of how a patient will respond to severe traumatic brain injury. In young patients, an acute subdural hematoma is typically treated through neurosurgical operations. However, mortality and significant morbidity often result from this intervention, even in the young.
As patients age, their success rate of surgery drops dramatically, partially due to the fact that many older patients are using oral anticoagulant medications to treat cardiovascular diseases. These medications can complicate procedures and reduce recovery chances significantly.
Due to these problems, the majority of hospitals refuse to treat elderly patients with acute subdural hematomas surgically. The Neurosurgical Department in Helsinki University Hospital is one of the only exceptions to that rule.
Through their surgical interventions, researchers at the hospital have determined how a patients’ functional status before their injury and the use of oral anticoagulant medications influence the prognosis for older patients operated on for an acute subdural hematoma.
The study found that no patients who arrived at the hospital unconscious, had not been independent before the trauma, or who had used anticoagulants survived through surgical operations on subdural hematomas.
“What was surprising, however, was that patients who were conscious at presentation, who were not using anticoagulants or were independent before the operation, recovered quite well. The expected lifespan of these patients was comparable to their age-matched peers,” says MD, PhD Rahul Raj, one of the main authors.
“One should be careful to make to strong conclusions from such a small number of patients”, Raj points out in a press release, “but it seems that in approximately half of all cases, even elderly patients may benefit from surgery and recover to an independent life. It is important to note that included patients had an isolated acute subdural hematoma with no injuries to the brain tissue itself. This means that the results cannot be applied to patients with contusions or other intracranial injuries, whose treatment and prognosis are different.”
According to the researchers, the findings show the decision to operate or not should not be decided based on age alone.
This recommendation is somewhat controversial, as surgery for acute subdural hematoma is followed by intensive care and rehabilitation, which are very costly and can bring significant suffering to both patients and their families. Therefore is it essential to only perform surgery on patients who are likely to benefit.
“But how do you define a bad prognosis? If only one in ten patients recovers sufficiently to live at home, is the treatment worthwhile? If half of the treated patients die within the year, is the treatment worthwhile? This is not a medical decision,” the researchers emphasize.