The purpose of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) magic size based prediction from your Medical Research Council (MRC). according to the Glasgow End result Scale at one year was compared to the expected outcome according to the CRASH models.Results.97 individuals mean age 75 (SD 7) years 64 men were included. Two individuals were lost to follow-up; 48 died within 14 days. The expected versus the observed odds percentage (OR) for mortality was 2.65. Unfavorable end result (GOSE < 5) MK 0893 was observed at one year follow-up in 72% of individuals. The CRASH models expected unfavorable outcome in all individuals.Summary.The CRASH magic size overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI. 1 Intro Traumatic brain injury (TBI) is a major health problem with high mortality in severe TBI . For survivors the injury may cause long-standing deficits that interfere with independent living reduced levels of functioning and restrictions on activities . The incidence of TBI among the elderly is raising posing a substantial challenge on healthcare services within this group . Mortality is specially high among seniors individuals . A review of the literature indicated an overall mortality of 65% in severe TBI among individuals above 60 MK 0893 years older . The mortality was MK MK 0893 0893 nearly twice as Mouse monoclonal to GSK3B high among very old individuals (≥75 years) compared to individuals between 65 and 74 years. Long-term end result is also assumed to be worse in the elderly . This may be attributed to the consequences of biological ageing as well as chronic disease prevalence  therefore rendering the elderly more prone to complications . Assuming a poor prognosis may also influence the treatment strategies applied in older individuals  and consequently results in a self-fulfilling prophecy concerning outcome. MK 0893 One should keep in mind that actually old subject with very severe TBI admitted with Glasgow Come Scale scores between three and four may have a favorable end result . In addition older age (>65 years) offers actually been shown to forecast better long-term existence satisfaction . The progress in rigorous care and neurosurgical options increase the options for treatment and survival . Such treatment is definitely expensive  and it has been argued that clinicians treating these individuals need prognostic models guiding their treatment choices  and the elderly group should be no exclusion. Determining the prognosis after TBI is definitely challenging in particular when it comes to long-term practical consequences . Large samples covering the entire specter of individual and medical variations are needed . The Medical Study Council (MRC) CRASH (Corticosteroid Randomization after Significant Head Injury) trial is the largest medical trial carried out in individuals with traumatic mind injury . A web-based prognostic calculator for mortality and 6-month end result is developed based on these data available for medical use . The Scandinavian countries are characterized by high income equivalent access to health and sociable care solutions and long life expectancy (http://www.ssb.no/). Even though none of the Scandinavian countries were included in the trial the CRASH algorithm provides the option of high income country in the calculation. The data included in CRASH model are regularly recorded in the Norwegian stress centers and the specification of the older subpopulation with this database provided the rationale for choosing this model. Hence the aim of the present study was to evaluate the mortality and functional outcome in old and very old patients with severe TBI and compare the observed mortality and MK 0893 outcome to the predicted outcome according to the CRASH models. We also aimed to evaluate if more detailed descriptions of CT scans improved the prognostic accuracy and to which extent there were differences in the old and very old patients. 2 Material and Methods 2.1 Design and Study Region This project is part of a prospective multicenter cohort study comprising patients admitted with severe TBI to the regional hospitals in all four health regions in Norway during 2009 and 2010. Norway consists of a land area of 323 758?km2 and an adult population (aged ≥16 years) of 3.8 million (Statistics Norway). The Norwegian hospital structure includes local hospitals that serve small areas and regional trauma centres located in university hospitals that serve the local hospitals in the region. 2.2 Inclusion In the current project Norwegian residents.