Characteristics of Head Injury in the Aged.

Lee, Kyu; Lee, Kyeong Seok; Bae, Hack Gun; Yun, Il Gyu; Lee, In Soo

Original Article

Journal of Korean Neurosurgical Society 1990;19(7): 1001-1008.

Kyu Lee, Kyeong Seok Lee, Hack Gun Bae, Il Gyu Yun, In Soo Lee

Department of Neurosurgery, Soonchunhyang University, Chonan Hospital, Chonan, Korea.

ABSTRACT

We present a retrospective study on the characteristics of head injury in the aged(not less than 60 years of age). We selected 213 patients who were admitted to the Soonchunhyang University Chonan Hospital due to head injury from September 1986 to December 1989. For comparison, data from 889 patients who were less than 60 years of age during similar study period was used. In the aged, pedestrian traffic accident, slip or fall, and unknown trauma were common and a cause of head injury. While passenger's traffic accident and assault were more common in the young(less than 60 years of age). The initial Glasgow coma score(GCS) of 9-12 was more common in the aged, while that of 13-15 was more common in the young. The rate of intracranial mass lesion was 46.9% in the aged, while that of the young was 29.6%. Hemorrhagic contusion/intracerebral hematoma and subdural hematoma were common in the aged, while epidural hematoma was the most common lesional type in the young. The diffuse lesions were more common in the young. The frequency of the delayed lesions was 15.2% in the aged, while that of the young was 6.4%. Intracranial mass lesion without skull fracture was commonly observed in the aged. The probability of mass lesion was highest in the patients with GCS value of 9-12. It was highest(88.6%) in the aged patients with GCS value of 9-12. The rate of operative treatment was similar. However, for the patients who had no skull fractures or whose GCS value were 13-15, operations were more frequently performed in the aged than the young. The outcome of the aged was good recovery in 59.7%, moderate disability in 11.3%, severe disability/vegetative state in 4.7%, death in 16.9%, and transfer or self-discharged in 8.5%. That of the young was good recovery in 74.0% moderate disability in 7.6%, severe disability/vegetative state in 2.3%, death in 8.8%, and transfer or self-discharged in 7.3%. The mortality rate of the aged was 18.5% and that of the young was 9.5%. There were no significant differences in the rates of skull fracture, combined injuries, death due to extracranial causes, and the life span of the dead. This study revealed that the causes of head injury in the aged differ from those the young, and the rates of intracranial mass lesion and delayed were high, which increased the proportion of the patients with GCS value 9-12, operative treatment without skull fracture, and made the prognosis of the aged poor.

Key Words: Head injury; Age; Prognosis; Glasgow coma score; CT