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The acute postinjury phase is characterized by an increased frequency of space-occupying lesions, secondary medical complications, and overall mortality. Comparing patients older than and younger than 65 years old, Pentland et al. (1986) reported a threefold increase in intracranial hematomas in mild to moderate injuries; in severe injuries, there was no difference between age groups. However, another study comparing patients 60 years and older with patients ages 20–40 years with severe injuries (i.e., a Glasgow Coma Scale [GCS] score of 5 or less) noted a higher incidence of multiple brain lesions, hematoma, and contusions in the elderly patients (Pennings et al. 1993). Mortality in the older patient group was 79%, with one-third of these mortalities attributed to pulmonary, cardiac, or multisystem organ failure. By comparison, mortality in younger patients was 36%, all attributed to primary brain injury. Rothweiler et al. (1998) prospectively followed 411 hospitalized patients with mild to severe TBI ages 18–89 years for 1 year postinjury. Patients 60 years and older took longer than 7 days on average to become responsive to commands compared with less than 24 hours in younger patients. Additionally, the older patients were more likely to have complications such as cardiac arrest, ventriculitis, and sepsis. Thus, although mild injuries were associated with only slightly increased mortality and poorer outcomes in older versus younger patients, moderate and severe TBI were associated with substantially increased morbidity and mortality in the elderly. This may be related to both physiological aspects of aging and limitations of the GCS in assessing severity of injury in older patients. These findings suggest that a GCS score alone may underestimate the severity of brain injury in patients with age-related cognitive and physiological changes.

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Table Reference Number
Table 29–3. Traumatic brain injury (TBI) outcome and advanced age

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