Original Articles Outcomes of Patients with Severe Traumatic Brain Injury Who Have Glasgow Coma Scale Scores of 3 or 4 and Are Over 65 Years Old Alexandra Brazinova, 1 Walter Mauritz, 2 Johannes Leitgeb, 3 Ingrid Wilbacher, 4 Marek Majdan, 5 Ivan Janciak, 6 and Martin Rusnak 7 Abstract The goal of this study was to investigate the outcomes of patients with traumatic brain injury (TBI) who had Glasgow Coma Scale (GCS) scores of 3 or 4, and were aged 66 years or older. Between January 2001 and December 2005, 13 European centers enrolled patients with severe brain trauma. Data sets of all patients who had a GCS score of 3 or 4 and were 66 years of age or older were analyzed. Outcomes were classified according to the Glasgow Outcome Scale (GOS) 12 months post-trauma as ‘‘favorable’’ (GOS score of 4 or 5), or ‘‘unfa- vorable‘‘ (GOS score of 1–3); relevant data for patients of the two groups were compared. Variables were analyzed by univariate analyses (chi-square, Wilcoxon-Mann-Whitney, and Fisher’s exact tests), and a p value of <0.05 was considered significant. We analyzed 100 patients identified from the database as having GCS scores of 3 or 4 and age over 65 years. Factors having significant effects on outcomes were worse results of the Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), and Abbreviated Injury Scale (AIS) for the head. Closed or partially closed basal cisterns and/or midline shift >15 mm were also associated with unfavorable outcomes, as was subarachnoid hemorrhage (SAH). Patients with GCS scores of 3 or 4 who are older than 65 years have a poor, but not hopeless, prognosis. Confirmed factors predicting poor prognosis for this group of patients were closed basal cisterns and midline shift >15 mm on the first CT scan. Factors possibly related to favorable outcomes were female gender, lower trauma severity, open or partially open basal cisterns, and no midline shift on the first CT scan. Key words: Glasgow Coma Scale; Glasgow Outcome Scale; old age; traumatic brain injury Introduction T raumatic brain injury (TBI) has been called ‘‘the silent epidemic’’ (Pascrell, 2001). It has been estimated that TBI accounts for one million hospital admissions in the European Union (EU) each year (Hyder et al., 2007). During the last 10 years, the International Neurotrauma Research Organization (INRO) has coordinated projects in different European countries. An EU-funded project in the Balkan countries addressed issues of TBI guidelines and their implementation, and subsequent development of national policies. Another project was done in Austria (Leitgeb et al., 2007; Lenartova et al., 2007; Mauritz et al., 2007; Rosso et al., 2007; Rusnak et al., 2007a, 2007b), and smaller projects included centers from Slovakia. Purely observational data were collected for all of these projects, and the same data- base was used everywhere. Thus the INRO now has data for over 1000 patients with severe TBI that have already been used for various analyses (Mauritz et al., 2009). 1 International Neurotrauma Research Organization, Vienna, Austria, and Department of Public Health, Faculty of Health and Social Services, Trnava University, Trnava, Slovak Republic. 2 Anaesthesiology and Intensive Care Medicine, Trauma Hospital ‘‘Lorenz Boehler,’’ Vienna, and International Neurotrauma Research Organization, Vienna, Austria. 3 Department of Trauma Surgery, Medical University of Vienna, and International Neurotrauma Research Organization, Vienna, Austria. 4 Social Insurance Company, Vienna, Austria and International Neurotrauma Research Organization, Vienna, Austria. 5 Department of Public Health, Faculty of Health and Social Services, Trnava University, Trnava, Slovak Republic, and International Neurotrauma Research Organization, Vienna, Austria. 6 Data and IT, International Neurotrauma Research Organization, Vienna, Austria. 7 Department of Public Health, Health and Social Services, Trnava University, Trnava, Slovak Republic, and International Neurotrauma Research Organization, Vienna, Austria. JOURNAL OF NEUROTRAUMA 27:1549–1555 (September 2010) ª Mary Ann Liebert, Inc. DOI: 10.1089/neu.2010.1315 1549