The outcomes of head trauma due to road traffic accident in hospitalized elderly patients


1 Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran

2 Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran

3 Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran



Introduction: Head trauma is one of the most important causes of death in trauma centers. In particular, treatment of head injury in the elderly seems more complicated than that of the young and middle aged. This study aimed to identify the outcomes of head trauma due to road traffic accidents (RTAs) in elderly patients. Materials and Methods: In a descriptive-analytical study, records of 294 elderly patients with head trauma due to RTA retrieved from health information system were reviewed using a checklist. The outcomes of patients were evaluated using the Glasgow Outcome Scale. Complete recovery and partial disability were considered as favorable outcomes, whereas severe disability, vegetative state, and death were defined as unfavorable outcomes. Descriptive factors and adjusted coefficients were calculated using SPSS software. Results: Of 294 elderly patients, 77.2% were men. About half of the road accidents had occurred in urban areas (58.8%). Less than half of the injured elderly were pedestrian (44.9%). The mean Glasgow Coma Scale of patients equaled 13.42 ± 3.29. Unfavorable outcomes were observed only in 20.4% of the patients. There were significant differences in head injury severity between the groups with favorable and unfavorable outcomes (p  < 0.05). Moreover, intraventricular hemorrhage was significantly associated with the highest prevalence of unfavorable outcome followed by intracranial hemorrhage. Conclusion: The results of our study mentioned that most of the elderly who had accidents were pedestrian, most of which occurred in the cities. Moderate and severe head injuries in patients had unfavorable clinical outcome.


1. World Health Organization. Global Status Report on Road Safety 2018. Licence: CC BYNCSA 3.0 IGO. Geneva: World Health Organization; 2018. 
2. Rohani‑Rasaf M, Mehrabi Y, Hashemi‑Nazari SS, Looha MA, Soori H. The role of interaction‑based effects on fatal accidents using logic regression. Arch Trauma Res 2018;7:140. 
3. Etehad H, Yousefzadeh‑Chabok SH, Davoudi‑Kiakalaye A, Moghadam Dehnadi A, Hemati H, Mohtasham‑Amiri Z. Impact of road traffic accidents on the elderly. Arch Gerontol Geriatr 2015;61:489‑93. 
4. O’Keeffe F, Dockree P, Moloney P, Carton S, Robertson IH. Awareness of deficits in traumatic brain injury: A multidimensional approach to assessing metacognitive knowledge and online‑awareness. J Int Neuropsychol Soc 2007;13:38‑49. 
5. Borkar SA, Sinha S, Agrawal D, Satyarthee GD, Gupta D, Mahapatra AK. Severe head injury in the elderly: risk factor assessment and outcome analysis in a series of 100 consecutive patients at a Level 1 trauma centre. Indian Journal of Neurotrauma. 2011;8:77-82. 
6. Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: A global perspective. NeuroRehabilitation 2007;22:341‑53. 
7. Richmond R, Aldaghlas TA, Burke C, RizzoAG, Griffen M, Pullarkat R, et al. Age: Is it all in the head? Factors influencing mortality in elderly patients with head injuries. J Trauma 2011;71:E8‑E11. 
8. Monsef Kasmaei V, Asadi P, Zohrevandi B, Raouf MT. An epidemiologic study of traumatic brain injuries in emergency department. Emerg (Tehran) 2015;3:141‑5. 
9. Sanaei‑Zadeh H, Vahabi R, Nazparvar B, Amoei M. An epidemiological study and determination of causes of traffic accident‑related deaths in Tehran, Iran (during 2000‑2001). J Clin Forensic Med 2002;9:74‑7. 
10. Azami‑Aghdash S, Aghaei MH, Sadeghi‑Bazarghani H. Epidemiology of road traffic injuries among elderly people; A systematic review and meta‑analysis. Bull Emerg Trauma 2018;6:279‑91. 
11. LeBlanc J, de Guise E, Gosselin N, Feyz M. Comparison of functional outcome following acute care in young, middle‑aged and elderly patients with traumatic brain injury. Brain Inj 2006;20:779‑90. 
12. Frankel JE, Marwitz JH, Cifu DX, Kreutzer JS, Englander J, Rosenthal M, et al. A follow‑up study of older adults with traumatic brain injury: Taking into account decreasing length of stay. Arch Phys Med Rehabil 2006;87:57‑62. 
13. Shimoda K, Maeda T, Tado M, Yoshino A, Katayama Y, Bullock MR, et al. Outcome and surgical management for geriatric traumatic brain injury: Analysis of 888 cases registered in the Japan neurotrauma data bank. World Neurosurg 2014;82:1300‑6. 
14. Papa L, Mendes ME, Braga CF. Mild traumatic brain injury among the geriatric population. Curr Transl Geriatr Exp Gerontol Rep 2012;1:135‑42. 
15. Coronado VG, Thomas KE, Sattin RW, Johnson RL. The CDC traumatic brain injury surveillance system: Characteristics of persons aged 65 years and older hospitalized with a TBI. J Head Trauma Rehabil 2005;20:215‑28. 
16. Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: Epidemiology, outcomes, and future implications. J Am Geriatr Soc 2006;54:1590‑5. 
17. Abou‑Raya S, ElMeguid LA. Road traffic accidents and the elderly. Geriatr Gerontol Int 2009;9:290‑7. 
18. Gaetani P, Revay M, Sciacca S, Pessina F, Aimar E, Levi D, et al. Traumatic brain injury in the elderly: Considerations in a series of 103 patients older than 70. J Neurosurg Sci 2012;56:231‑7. 
19. Santos AM, Rodrigues RA, Diniz MA. Trauma in the elderly caused by traffic accident: integrative review. Revista da Escola de Enfermagem da USP. 2015;49:162-72. 
20. Sinha VD, Gupta V, Singh DK, Chopra S, Gupta P, Bagaria H. Geriatric head injuries – Experience and expectations. Indian J Neurotrauma 2008;5:69‑73. 
21. Borkar SA, Sinha S, Agrawal D, Satyarthee GD, Gupta D, MahapatraAK. Severe head injury in the elderly: Risk factor assessment and outcome analysis in a series of 100 consecutive patients at a level 1 trauma centre. Indian J Neurotrauma 2011;8:77‑82. 
22. Timler D, Dworzyński MJ, Szarpak Ł, Gaszyńska E, Dudek K, Gałązkowski R. Head trauma in elderly patients: Mechanisms of injuries and CT findings. Adv Clin Exp Med 2015;24:1045‑50. 
23. Hadirzadeh MR, Fadaye Vatan R, Akbari Kamrani AA, Davatgaran K, Hashemi Nazari SS, Mirtorabi SD. Road accident mortality rate of the Iranian elderly from 2006 to 2008. Salmand 2012;7:49‑56. 
24. Yeo YY, Lee SK, Lim CY, Quek LS, Ooi SB. A review of elderly injuries seen in a Singapore emergency department. Singapore Med J 2009;50:278‑83. 
25. Ruelas González MG, Salgado de Snyder VN. Accidental injuries in older adults: Achallenge for the health systems. Salud Publica Mex2008;50:463‑71. 26. Røe C, Skandsen T, Manskow U, Ader T, Anke A. Mortality and one‑year functional outcome in elderly and very old patients with severe traumatic brain injuries: Observed and predicted. Behav Neurol 2015;2015:845491. 
27. Susman M, DiRusso SM, Sullivan T, Risucci D, Nealon P, Cuff S, et al. Traumatic brain injury in the elderly: Increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma 2002;53:219‑23.