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Cited by 641Traumatic Brain Injury and Neurovascular DisturbancesTraumatic Brain Injury ResearchTrauma and Emergency Care Studies

Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients

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Hukkelhoven, Chantal W. P. M., Steyerberg, Ewout W., Rampen, Anneke J. J., Farace, Elana, Habbema, J. Dik F., Marshall, Lawrence F., Murray, Gordon D., Maas, Andrew I. R.·2003·Journal of Neurosurgery
DOI 10.3171/jns.2003.99.4.0666
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Abstract

Object. Increasing age is associated with poorer outcome in patients with closed traumatic brain injury (TBI). It is uncertain whether critical age thresholds exist, however, and the strength of the association has yet to be investigated across large series. The authors studied the shape and strength of the relationship between age and outcome, that is, the 6-month mortality rate and unfavorable outcome based on the Glasgow Outcome Scale. Methods. The shape of the association was examined in four prospective series with individual patient data (2664 cases). All patients had a closed TBI and were of adult age (96% < 65 years of age). The strength of the association was investigated in a metaanalysis of the aforementioned individual patient data (2664 cases) and aggregate data (2948 cases) from TBI studies published between 1980 and 2001 (total 5612 cases). Analyses were performed with univariable and multivariable logistic regression. Proportions of mortality and unfavorable outcome increased with age: 21 and 39%, respectively, for patients younger than 35 years and 52 and 74%, respectively, for patients older than 55 years. The association between age and both mortality and unfavorable outcome was continuous and could be adequately described by a linear term and expressed even better statistically by a linear and a quadratic term. The use of age thresholds (best fitting threshold 39 years) in the analysis resulted in a considerable loss of information. The strength of the association, expressed as an odds ratio per 10 years of age, was 1.47 (95% confidence interval [CI] 1.34–1.63) for death and 1.49 (95% CI 1.43–1.56) for unfavorable outcome in univariable analyses, and 1.39 (95% CI 1.3–1.5) and 1.46 (95% CI 1.36–1.56), respectively, in multivariable analyses. Thus, the odds for a poor outcome increased by 40 to 50% per 10 years of age. Conclusions. An older age is continuously associated with a worsening outcome after TBI; hence, it is disadvantageous to define the effect of age on outcome in a discrete manner when we aim to estimate prognosis or adjust for confounding variables.

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Authors
Hukkelhoven, C. W. P. M., Steyerberg, E. W., Rampen, A. J. J., Farace, E., Habbema, J. D. F., Marshall, L. F., Murray, G. D., & Maas, A. I. R.
Affiliations
Erasmus MC (NL)
ORCID
Venue
Journal of Neurosurgery
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Published
2003-10
Volume
99
Issue
4
Pages
666-673
ISSN
0022-3085 (ISSN-L)
DOI
10.3171/jns.2003.99.4.0666
OpenAlex
W2119835440
Cited by
641
References
54
Citations by year
2026: 19 · 2025: 22 · 2024: 22 · 2023: 32 · 2022: 41 · 2021: 24 · 2020: 32 · 2019: 45 · 2018: 38 · 2017: 44 · 2016: 28 · 2015: 36 · 2014: 33 · 2013: 34 · 2012: 46
FWCI
1.20
Type
journal article
Language
en
Open access
Locations
  • Journal of neurosurgery (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • Socio-Environmental Systems Modeling (acceptedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords
traumatic brain injury, patient age, mortality, Glasgow Outcome Scale, prognostic factors, age limits, individual patient data
MeSH terms
Adult, Age Factors, Aged, Brain Injuries, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Prospective Studies, Glasgow Coma Scale, Survival Rate, Multivariate Analysis, Logistic Models

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