We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Survival After Severe Brain Injury in the Aged

John L. Pennings, MD; Ben L. Bachulis, MD; Christopher T. Simons; Tess Slazinski, RN
Arch Surg. 1993;128(7):787-794. doi:10.1001/archsurg.1993.01420190083011.
Text Size: A A A
Published online


Objective:  We studied the impact of age on outcomes for patients with severe blunt brain injury.

Design:  Inception cohort, retrospective study, cost-benefit analysis.

Setting:  Level 1 trauma center.

Patients:  Ninety consecutive patients aged 60 years or older were compared with 79 randomly selected patients aged 20 to 40 years, all with Glasgow Coma Scale scores of 5 or less. These patients were admitted from January 1, 1983, to September 1, 1991. Patients who died less than 6 hours after admission to the hospital, had cranial gunshot wounds, or had no structural brain injury on computed tomographic scans were excluded, leaving 42 elderly and 50 younger patients for the final analysis.

Main Outcome Measures:  Mortality rates and quality of survival as measured by the Glasgow Outcome Scale scores.

Results:  There were no differences between the older and younger patients in admission Glasgow Coma Scale score, Revised Trauma Score, Injury Severity Score, or Abbreviated Injury Scale 1 score. Resuscitation, neurosurgical interventions, and adequacy of nutritional support were equivalent. Elderly patients had a higher incidence of brain confusion and more frequently had multiple brain lesions. Thirty-three (79%) of the 42 elderly patients died in the hospital. Death was attributed to secondary organ failure in 33% of these elderly patients. In-hospital mortality was 36% for younger patients, all of whom died of brain injury. On the basis of the Glasgow Outcome Scale, only one elderly survivor made a favorable recovery (2%) compared with 38% of young patients. Total charges per favorable outcome were $1 540 971 for the elderly compared with $154 155 for the young.

Conclusions:  Elderly patients experienced higher mortality, had poorer functional recovery, more frequently died of secondary organ failure, and consumed more resources per favorable outcome than did younger patients with similar injury profiles despite equivalent treatment efforts.(Arch Surg. 1993;128:787-794)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.