Surgical Decision Making for the Elderly Patients in Severe Head Injuries

Lee, Kyeong-Seok; Shim, Jae-Jun; Yoon, Seok-Man; Oh, Jae-Sang; Bae, Hack-Gun; Doh, Jae-Won

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자료유형: 학술저널

저자정보: Lee, Kyeong-Seok (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) Shim, Jae-Jun (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) Yoon, Seok-Man (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) Oh, Jae-Sang (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) Bae, Hack-Gun (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) Doh, Jae-Won (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital)

저널정보: 대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제55권 제4호

발행연도: 2014.1

수록면: 195 - 199 (5page)

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Objective : Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. Methods : We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3--8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. Results : Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. Conclusion : Ethical training and developing decision-making skills are necessary including shared decision making.

#Prognosis #Decision making #Patient participation #Craniocerebral trauma

참고문헌 (25)

참고문헌 신청

Andrews PJ / 2002 / Predicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data : a comparison between decision tree analysis and logistic regression / J Neurosurg 97:326~336

Cagetti B / 1992 / The outcome from acute subdural and epidural intracranial haematomas in very elderly patients / Br J Neurosurg 6:227~231

Chamoun RB / 2009 / Outcome in patients with blunt head trauma and a Glasgow Coma Scale score of 3 at presentation / J Neurosurg 111:683~687

Chaudhuri K / 2009 / Survival of trauma patients with coma and bilateral fixed dilated pupils / Injury 40:28~32

Frosch DL / 1999 / Shared decision making in clinical medicine : past research and future directions / Am J Prev Med 17:285~294

이 논문의 저자 정보

Lee, Kyeong-Seok

소속기관 Department of Neurosurgery, Soonchunhyang University Chonan Hospital

주요연구분야 의약학 > 임상의학 > 신경외과학

논문수 26 이용수 71

Shim, Jae-Jun