Predictors of mortality in older patients with isolated severe head injury: a data linkage study from New South Wales, Australia

摘要

Objective. This study aimed to identify factors associated with 90-day mortality in older patients with a severe head injury. Methods. A data linkage study was performed with the New South Wales Trauma Registry, Admitted Patient Data Collection and Registry of Births Deaths and Marriages to identify patients aged ≥75 years with isolated severe head injury presenting to trauma hospitals between 2012 and 2016. The primary outcome was all-cause mortality at 90 days. Results. In all, 2045 patients were included in the analysis. The mean (±s.d.) age was 84.5 ± 5.6 years. Falls accounted for 93.7% of this cohort. In-hospital mortality was 28.2% and 90-day mortality was 60.7%. Clinical variables associated with increased 90-day mortality were a Glasgow Coma Scale (GCS) score ,9 on arrival (adjusted odds ratio (aOR) 1.43; 95% confidence interval (CI) 1.03-1.98; P = 0.03) and systolic blood pressure ≥ 180 mmHg on arrival (aOR 1.39; 95%CI 1.05-1.83; P = 0.02). The most important predictor of 90-day mortality was the presence of severe intracranial injury based on computed tomography (CT) imaging. Increasing age and comorbidities were not associated with increased mortality in this cohort. Conclusions. A GCS score ,9, severe intracranial injury on CT imaging and severe hypertension on arrival to the emergency department were the variables most strongly predictive of mortality at 90 days after isolated severe head injury in older patients.