The Influence of Age on the Outcomes of Traumatic Brain Injury: Findings from a Japanese Nationwide Survey (J-ASPECT Study-Traumatic Brain Injury)

Keitaro Yamagami; Ryota Kurogi; Ai Kurogi; Kunihiro Nishimura; Daisuke Onozuka; Nice Ren; Akiko Kada; Ataru Nishimura; Koichi Arimura; Keisuke Ido; Masahiro Mizoguchi; Tetsuya Sakamoto; Takamasa Kayama; Michiyasu Suzuki; Hajime Arai; Akihito Hagihara; Koji Iihara; J-ASPECT Study Collaborators

doi:10.1016/j.wneu.2019.05.140

The Influence of Age on the Outcomes of Traumatic Brain Injury: Findings from a Japanese Nationwide Survey (J-ASPECT Study-Traumatic Brain Injury)

World Neurosurg. 2019 Oct:130:e26-e46. doi: 10.1016/j.wneu.2019.05.140. Epub 2019 May 24.

Authors

Keitaro Yamagami¹, Ryota Kurogi¹, Ai Kurogi¹, Kunihiro Nishimura², Daisuke Onozuka³, Nice Ren¹, Akiko Kada⁴, Ataru Nishimura¹, Koichi Arimura¹, Keisuke Ido¹, Masahiro Mizoguchi¹, Tetsuya Sakamoto⁵, Takamasa Kayama⁶, Michiyasu Suzuki⁷, Hajime Arai⁸, Akihito Hagihara³, Koji Iihara⁹; J-ASPECT Study Collaborators

Collaborators

J-ASPECT Study Collaborators:
Masayoshi Takigami, Kenji Kamiyama, Kiyohiro Houkin, Shougo Nishi, Tetsuyuki Yoshimoto, Sadao Kaneko, Koji Oka, Hiroshi Ooyama, Kyousuke Kamada, Kenichi Makino, Naoki Tokumitsu, Kazuhiro Sako, Naoki Tokumitsu, Susumu Suzuki, Nozomi Suzuki, Naoto Izumi, Kazumi Nitta, Masahumi Ootaki, Masanori Isobe, Mikio Nishiya, Takaaki Yamazaki, Syouji Mabuchi, Kuniaki Ogasawara, Naohiko Kubo, Yukihiko Shimizu, Keiichi Saito, Tatumi Yamanome, Atsuo Yoshino, Mitsuyuki Fujitsuka, Masaaki Takami, Hirotoshi Ohtaka, Teruyuki Hirano, Yosiaki Shiokawa, Takaharu Okada, Ichiro Suzuki, Michihiro Kohno, Jou Haraoka, Yoshinori Arai, Noriyoshi Kawamura, Akira Isoshima, Masaharu Yasue, Mitsuhiko Hokari Takayoshi Kobayashi, Kensuke Kawai, Taketoshi Maehara, Hajime Arai, Makoto Noguchi, Haruhiko Hoshino, Hirofumi Hiyama, Kensaku Yoshida, Osamu Utsugi, Yasuaki Takeda, Kouichi Tamaki, Hirohide Karasudani, Takao Urabe, Shiro Kobayashi, Michio Nakamura, Yorio Koguchi, Junichi Ono, Sumio Suda, Hiromu Hadeishi, Toshio Fukutake, Kenji Wakui, Hirokazu Tanno, Naoki Ishige, Takashi Ohasi, Hideki Sakai, Yasuaki Nishimura, Takayuki Watanabe, Takashi Matsumoto, Naoki Koketsu, Yuichi Hirose, Manabu Doyu, Toshinori Hasegawa, Naoto Kuwayama, Shinichi Terao, Nobuhiko Mizutani, Noriyuki Suzaki, Satoshi Okuda, Keizo Yasui, Yukio Seki, Yasuhiro Hasegawa, Akira Ikeda, Youtarou Takeuchi, Sigeki Ohara, Yoshio Araki, Toshihiko Wakabayashi, Hisashi Tanaka, Junpei Yoshimoto, Makoto Sugiura, Ogura Koichiro, Nozomu Kobayashi, Tomonori Yamada, Amami Kato, Ohtsuki Toshiho, Akatsuki Wakayama, Jun Takahashi, Hiroharu Kataoka, Toshiki Yoshimine, Yoshikazu Nakajima, Hidehuku Gi, Ryunosuke Uranishi, Yusaku Nakamura, Kazunori Yamanaka, Kazumi Ohmori, Hiroyuki Matsumoto, Yoshitugu Oiwa, Yosihiko Uemura, Hiroaki Fujiwara, Yoshiyasu Iwai, Masashi Morikawa, Kazuyuki Tane, Kazuo Hashikawa, Toshiyuki Fujinaka, Shunichi Yoneda, Kohsuke Yamashita, Masahiko Kitano, Shinsuke Tominaga, Kazuhito Nakamura, Katsuhiko Kono, Kenji Ohata, Hirokatsu Taniguchi, Takanori Hazama, Toshihiko Kuroiwa, Yoji Tamura, Kazusige Maeno, Motohiro Arai, Masaaki Iwase, Kenji Hashimoto, Keisuke Yamada, Takashi Turuno, Tsutomu Ichinose, Shinichiro Kurokawa, Takeshi Matsuyama, Toshiaki Fujita, Takamichi Yuguchi, Yoshihumi Teramoto, Hiroto Kakita, Takayuki Matsuo, Tsuyoshi Izumo, Nobutoshi Ryu, Wataru Haraguchi Naoki Kitagawa, Makio Kaminogo, Seisaburo Sakamoto, Yosiharu Tokunaga, Ei-Ichirou Urasaki, Junichi Kuratsu, Akira Takada, Tadashi Terasaki, Isao Fuwa Hisami Oosima, Shigeo Yamashiro, Makoto Yoshikawa Hiromasa Tsuiki, Kazunari Koga, Hiroshi Egami, Tadao Kawamura, Kunihiko Mitsuo, Takamitu Hikawa Masaki Morisige, Yuu Takeda, Yutaka Yamaguchi, Shiro Miyata Shunro Uchinokura, Tomokazu Goya, Hideo Takeshima, Kazutaka Yatsushiro, Hajime Ohta, Tatsui Nagadou, Kazuho Hirahara, Souichi Obara, Hiroshi Seto, Koiti Moroki, Kazunori Arita, Shogo Ishiuchi, Toshimitsu Uchihara, Susumu Mekaru, Tomoaki Nagamine, Naoki Tomiyama Jin Momoji, Kouzi Idomari Atusi Kimoto, Tsutomu Kadekaru, Hirosi Syamoto, Osamu Sasaki, Makoto Minagawa, Hideaki Takahashi, Kiyoshi Onda Hiroyuki Arai, Shigekazu Takeuchi, Hiroshi Abe, Osamu Fukuda, Mitsuo Kouno, Tetsuro Tamura, Yukio Horie Michiya Kubo, Hiroaki Hondo, Hisashi Takada, Toru Masuoka, Naoki Shirasaki, Hisashi Nitta, Makoto Kimura Yasuo Katsuki, Yutaka Hayashi Hisato Minamide, Shigeru Munemoto, Kiyonobu Ikeda, Mitsutoshi Nakada Yutaka Hayashi, Syuji Sato, Taketo Hatano, Osamu Yamamura, Masanori Kabuto, Takahiro Sakuma Jyunya Hayashi, Hiroyuki Kinouchi, Hidehito Koizumi, Syougo Imae, Manabu Fujita, Masakazu Suga, Shinji Iwata Kanehisa Kohno, Kiichiro Zenke, Mutsuo Fujisawa, Hikaru Mizobuchi, Satoru Hayashi, Masanori Morimoto, Tetsuya Ueba, Hiroyuki Nishimura, Naoki Ikawa, Yuzo Matsumoto, Seiji Kannuki, Masahiro Kagawa, Naoki Hayashi, Takashi Tamiya Atsushi Shindo, Kimihiro Yoshino, Tetsuya Masaoka, Ichiro Nakahara, Akira Nakamizo Satoshi Suzuki, Yuji Okamoto, Haruki Takahashi, Koji Iihara, Katsuyuki Hirakawa, Shinji Nagata, Akio Ookura, Hidenori Yoshida Yoshiro Kaneko, Hiroshi Nakane, Isao Inoue, Tsutomu Hitotsumatsu, Terukazu Kuramoto Kouichi Kuramoto, Yoshihisa Matumoto Hiromichi Ooishi, Tooru Inoue Masani Nonaka, Motohiro Morioka, Hiroshi Sugimori Shuji Sakata, Hiroshi Takashima, Shin-Ichiro Ishihara, Kenji Suzuyama, Masayuki Miyazono, Masafumi Morimoto Itaro Hattori, Satoshi Ozaki, Nobuo Hirota, Yasunori Takemoto Yasuhiko Mochimatsu, Makoto Takagi, Isao Yamamoto Kenji Nakayama, Yoshinori Uchida Hiroshi Tanaka, Katsumi Sakata, Kawahara Nobutaka, Motohiro Nomura, Hitoshi Ozawa, Kotaro Tsumura, Makoto Inaba Michiyuki Maruyama, Tatsuro Mori, Takahisa Mori, Masato Sugitani, Yuichiro Tanaka, Masaru Yamada, Mitsunori Matsumae, Keiichirou Onitsuka, Kosuke Miyahara Tatsuya Takahashi, Sumio Endou, Hidekazu Takahashi, Hiroyuki Kaidu, Akira Tsunoda Chikashi Maruki, Takamitsu Fujimaki, Hidetoshi Ooigawa, Masahiko Tanaka Masatsugu Uchida, Hiroshi Wanihuti Kouiti Katoh, Akio Hyodo, Ken Asakura, Shigeyoshi Nakajima, Takao Kanzawa, Hideyuki Kurihara, Sigehiro Ohmori, Mitsugi Yoshinao Hiroshi Kusunoki, Satoshi Magarisawa, Shinichi Okabe, Yuuji Kujiraoka, Shin Tsuruoka, Mikihiko Takeshita, Tetsuya Yamamoto Akira Matsumura, Kazuya Uemura, Hitoshi Tabata, Makoto Sonobe, Masashi Nakatsukasa Ryoji Yoshida, Norifumi Shimoeda, Hideo Kunimine, Masayuki Ishihara, Nozomu Murai, Nobukuni Murakami, Minoru Kidooka, Yoshihiro Iwamoto, Hiroshi Tenjin, Kouji Shiga Masahiko Takamasu, Nobuhito Mori, Shigeru Kose, Eiji Kohmura, Keigo Matsumoto, Takayuki Sakaki, Hiroji Miyake, Eiichiro Mabuchi, Masayuki Yokota, Hideyuki Ohnishi Yosihiro Kuga, Mitsuru Kimura, Osamu Narumi Masaaki Saiki, Norio Nakajima, Minoru Asahi, Junji Koyama, Shinya Noda, Junichi Iida, Toyohisa Fujita, Hiroyuki Nakase, Hidehiro Hirabayashi Toru Hoshida, Takayoshi Fujimoto, Naoyuki Nakao, Yoshiyuki Tanaka, Fuminori Ozaki, Yoshinari Nakamura, Kazuhito Miki, Takashi Watanabe, Seiko Hasegawa, Hiromu Konno, Atsuhito Takemura, Atsuya Okubo, Hitoshi Saito, Tatsuya Ishikawa Taizen Nakase, Hiroaki Shimizu Toshio Sasajima, Masayuki Sasou, Yoichi Watanabe, Taku Sato Kiyoshi Saito, Satoshi Taira Masahiro Satoh, Takayuki Koizumi, Yasuhiro Suzuki Shoji Mashiyama, Tomoyoshi Oikawa, Yukihiko Sonoda, Rei Kondo Shinjiro Saito, Atsuo Shinoda, Eiichiro Kamatsuka, Keiten So, Toshihiko Kinjo, Tooru Sasaki Kennji Itou, Hidenori Endo Hiroaki Shimizu, Hirosi Karibe, Kou Takahashi, Masayuki Nakajima, Kazuyoshi Watanabe, Motohiro Takayama, Taro Komuro, Hisao Hirai Fumio Suzuki, Hidenori Suzuki, Hiroto Murata, Fumitaka Miya, Kenji Kanamaru, Akira Tamura, Kiyoshi Harada, Seiji Fukazawa, Seiya Takehara, Yoshihiko Watanabe, Teiji Nakayama, Haruhiko Sato Hiroshi Nagura, Shinji Amano Chiharu Tanoi, Katsuhiro Kuroda, Satoru Morooka, Takafumi Wataya Masashi Kitagawa, Kazuo Koide, Tetsuya Tanigawara, Toru Iwama, Junki Ito, Shinji Noda, Kazuyuki Kouno, Kazuo Kitazawa, Yoshikazu Kusano Toshiki Takemae, Masanobu Hokama, Hiroki Sato Yoshihisa Nishiyama, Tatsuya Seguchi, Sumio Kobayashi Yoshihiko Inui, Youji Oohigashi, Shinsuke Muraoka, Masaki Miyatake, Kensuke Hayashida Nakagawa Shinichi, Atsushi Inoue, Keiichi Sakai, Shuhei Yamaguchi, Tatsuya Mizoue Fusao Ikawa, Gen Ishida Hideki Irie, Takato Kagawa, Yoichiro Namba, Hiroyuki Nakashima, Isao Date Koji Abe, Masaaki Uno, Masaki Chin Sen Yamagata, Hidemiti Sasayama Soitiro Takao, Hideyuki Yoshida Kouji Muneda, Akira Watanebe, Syouichi Katou, Yasuhiro Hamada, Michiyasu Suzuki, Takafumi Nishizaki, Katsuhiro Yamashita, Takaharu Nakamura Ryuji Nakamura, Shinichi Wakabayashi, Takahito Okazaki, Kaoru Kurisu, Masayasu Matsumoto, Atsushi Tominaga Katsuzo Kiya, Masaaki Shibukawa Syuichi Oki, Toshinori Nakahara, Shinji Okita, Tuyosi Torii, Minoru Nakagawa Kenjirou Fujiwara, Takashi Matsuoka Syuuhei Nishimura, Osamu Hamasaki Naoyuki Isobe, Junichiro Satomi Shinji Nagahiro, Masahito Agawa, Hirofumi Oka, Kunikazu Yoshimura, Tsutomu Kato, Nobuaki Kobayasi Satoshi Minoshima, Nobuhiro Mikuni, Rokuya Tanikawa, Jyunkou Sasaki, Yasunari Otawara, Teiji Tominaga, Tatsuya Sasaki, Sunao Takemura, Masahisa Kawakami, Satoshi Ihara, Yasushi Shibata, Takashi Saegusa, Toshihiko Iuchi, Chiaki Ito, Osamu Okuda, Kazunari Yoshida, Sadao Suga Masateru Katayama, Oikawa Akihiro, Naohisa Miura, Takahiro Ota, Toshihiro Kumabe, Sachio Suzuki, Takashi Kumagai, Keiichi Nishimaki, Kazuhiro Hongo, Hiroaki Shigeta, Kazuyoshi Hattori, Yoichi Uozumi, Norimoto Nakahara, Nobukazu Hashimoto, Shinichi Shirakami Shu Imai, Yoshinari Okumura, Ryo Tamaki Kazuhiro Yokoyama, Susumu Miyamoto, Kenji Hashimoto, Kazuo Yamamoto, Tsugumichi Ichioka, Tsuyoshi Inoue, Manabu Kinoshita, Minoru Saitoh, Hideo Aihara, Hajimu Miyake, Kotaro Ogihara Tukasa Nishiura, Shigeki Nishino, Yasuyuki Miyoshi, Tadashi Arisawa, Shigeru Daido Shoji Tsuchimoto, Kimihisa Kinoshita, Kiyoshi Yuki Keisuke Migita, Keiichi Akatsuka, Hirosuke Fujisawa, Tadahisa Shono, Hitoshi Tsugu, Shuji Hayashi, Tatsuya Abe Toshio Matsushima, Susumu Nakashima, Takehisa Tuji, Akihiko Kaga, Reizou Kanemaru, Koji Takasaki, Junichi Imamura, Masahiro Noha, Saburo Watanabe, Nobuyuki Sakai, Yasuhisa Yoshida Hiroaki Minami, Tomoyoshi Okumura, Shinjitsu Nishimura, Shinichi Numazawa, Kiyoshi Kazekawa Masanori Tsutsumi, Kouzou Fukuyama, Yasuhiro Fujimoto

Affiliations

¹ Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
² Department of Preventive Medicine, Director, National Cerebral and Cardiovascular Center, Suita, Japan.
³ Department of Health Communication, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁴ Department of Clinical Research Management, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
⁵ Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan.
⁶ Department of Advanced Cancer Science, Yamagata University Faculty of Medicine, Yamagata, Japan.
⁷ Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan.
⁸ Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
⁹ Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: kiihara@ns.med.kyushu-u.ac.jp.

PMID: 31132488
DOI: 10.1016/j.wneu.2019.05.140

Abstract

Background: The epidemiology of patients with traumatic brain injury (TBI) has changed dramatically over recent decades as a result of rapid advances in aging societies. We assessed the influence of age on outcomes of patients with TBI and sought to identify prognostic factors for in-hospital mortality of TBI among elderly patients.

Methods: Using a nationwide database, we analyzed data from 5651 patients with TBI. Univariate analysis was conducted to compare patient demographics, neurologic status on admission, radiologic findings, systemic complication rates, length of hospital stay, in-hospital mortality, and home discharge rates between elderly and nonelderly groups. Multivariable analysis was conducted to determine prognostic factors for in-hospital mortality among elderly patients.

Results: Overall in-hospital mortality was significantly higher in elderly patients (12.8% vs. 19.3%; P < 0.001). In-hospital mortality of elderly patients with mild TBI increased significantly at >7 days after admission, whereas that of elderly patients with moderate or severe TBI was significantly higher immediately after admission. Age (odds ratio [OR], 1.62; P = 0.024), male sex (OR, 1.30; P = 0.004), Japan Coma Scale score on admission (OR, 5.95, P < 0.001), and incidence of acute subdural hematoma (OR, 1.89; P < 0.001) were associated with in-hospital mortality in elderly patients with TBI.

Conclusions: Elderly patients with TBI showed significantly higher in-hospital mortality. Delayed increases in in-hospital mortality were observed among elderly patients with mild TBI. Level of consciousness on admission was the strongest predictor of in-hospital mortality among elderly patients.

Keywords: Aging; Hospital mortality; Prognosis; Subdural hematoma; Traumatic brain injury.

MeSH terms

Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Brain Injuries, Traumatic / epidemiology*
Child
Child, Preschool
Databases, Factual
Female
Hospital Mortality
Humans
Infant
Infant, Newborn
Japan / epidemiology
Male
Middle Aged
Patient Discharge / statistics & numerical data
Retrospective Studies
Surveys and Questionnaires
Young Adult