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Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study.
Arch Phys Med Rehabil. 2010 Jan; 91(1):20-9.AP

Abstract

Ventura T, Harrison-Felix C, Carlson N, DiGuiseppi C, Gabella B, Brown A, DeVivo M, Whiteneck G. Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study.

OBJECTIVE

To characterize mortality after acute hospitalization with traumatic brain injury (TBI) in a socioeconomically diverse population.

DESIGN

Population-based retrospective cohort study.

SETTING

Statewide TBI surveillance program.

PARTICIPANTS

Colorado residents with TBI discharged alive from acute hospitalization between 1998 and 2003 (N=18,998).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Vital status at the end of the study period (December 31, 2005) and statewide population mortality rates were used to calculate all-cause and cause-specific standardized mortality ratios (SMRs) and life expectancy compared with population mortality rates. The influence of demographics, injury severity, and comorbid conditions on time until death was investigated using age-stratified Cox proportional hazards modeling.

RESULTS

Patients with TBI carried about 2.5 times the risk of death compared with the general population (SMR=2.47; 95% confidence interval [CI], 2.31-2.65). Life expectancy reduction averaged 6 years. SMRs were largest for deaths caused by mental/behavioral (SMR=3.84; 95% CI, 2.67-5.51) and neurologic conditions (SMR=2.79; 95% CI, 2.07-3.77) and were smaller but significantly higher than 1.0 for an array of other causes. Injury severity and older age increased mortality among young people (age <20y). However, risk factors for mortality among adults age 20 and older involved multiple domains of demographics (eg, metropolitan residence), injury-related measures (eg, falls versus vehicular incidents), and comorbidity (eg, > or =3 comorbid health conditions versus none).

CONCLUSIONS

TBI confers an increased risk of mortality in the months and years after hospital discharge. Although life expectancy is reduced across the population, the excess in mortality lessens as time since injury increases. Specific risk factors (eg, high injury severity, poor general health) pose an especially high threat to survival and should prompt an increased vigilance of health status, especially among younger patients.

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Authors+Show Affiliations

Ventura T
MSPH/MPH Program, Colorado School of Public Health, University of Colorado Denver, Denver, CO, USA.
Harrison-Felix C
No affiliation info available
Carlson N
No affiliation info available
Diguiseppi C
No affiliation info available
Gabella B
No affiliation info available
Brown A
No affiliation info available
Devivo M
No affiliation info available
Whiteneck G
No affiliation info available

MeSH

Abbreviated Injury ScaleAdolescentAdultAge FactorsAgedAged, 80 and overBrain InjuriesCause of DeathChildChild, PreschoolCohort StudiesComorbidityFemaleHospitalizationHumansInfantLife ExpectancyMaleMiddle AgedResidence CharacteristicsRetrospective StudiesSex FactorsSocioeconomic FactorsYoung Adult

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20103393

Citation

Ventura, Thomedi, et al. "Mortality After Discharge From Acute Care Hospitalization With Traumatic Brain Injury: a Population-based Study." Archives of Physical Medicine and Rehabilitation, vol. 91, no. 1, 2010, pp. 20-9.
Ventura T, Harrison-Felix C, Carlson N, et al. Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study. Arch Phys Med Rehabil. 2010;91(1):20-9.
Ventura, T., Harrison-Felix, C., Carlson, N., Diguiseppi, C., Gabella, B., Brown, A., Devivo, M., & Whiteneck, G. (2010). Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study. Archives of Physical Medicine and Rehabilitation, 91(1), 20-9. https://doi.org/10.1016/j.apmr.2009.08.151
Ventura T, et al. Mortality After Discharge From Acute Care Hospitalization With Traumatic Brain Injury: a Population-based Study. Arch Phys Med Rehabil. 2010;91(1):20-9. PubMed PMID: 20103393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study. AU - Ventura,Thomedi, AU - Harrison-Felix,Cynthia, AU - Carlson,Nichole, AU - Diguiseppi,Carolyn, AU - Gabella,Barbara, AU - Brown,Allen, AU - Devivo,Michael, AU - Whiteneck,Gale, PY - 2009/03/19/received PY - 2009/07/27/revised PY - 2009/08/13/accepted PY - 2010/1/28/entrez PY - 2010/1/28/pubmed PY - 2010/2/19/medline SP - 20 EP - 9 JF - Archives of physical medicine and rehabilitation JO - Arch Phys Med Rehabil VL - 91 IS - 1 N2 - UNLABELLED: Ventura T, Harrison-Felix C, Carlson N, DiGuiseppi C, Gabella B, Brown A, DeVivo M, Whiteneck G. Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study. OBJECTIVE: To characterize mortality after acute hospitalization with traumatic brain injury (TBI) in a socioeconomically diverse population. DESIGN: Population-based retrospective cohort study. SETTING: Statewide TBI surveillance program. PARTICIPANTS: Colorado residents with TBI discharged alive from acute hospitalization between 1998 and 2003 (N=18,998). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Vital status at the end of the study period (December 31, 2005) and statewide population mortality rates were used to calculate all-cause and cause-specific standardized mortality ratios (SMRs) and life expectancy compared with population mortality rates. The influence of demographics, injury severity, and comorbid conditions on time until death was investigated using age-stratified Cox proportional hazards modeling. RESULTS: Patients with TBI carried about 2.5 times the risk of death compared with the general population (SMR=2.47; 95% confidence interval [CI], 2.31-2.65). Life expectancy reduction averaged 6 years. SMRs were largest for deaths caused by mental/behavioral (SMR=3.84; 95% CI, 2.67-5.51) and neurologic conditions (SMR=2.79; 95% CI, 2.07-3.77) and were smaller but significantly higher than 1.0 for an array of other causes. Injury severity and older age increased mortality among young people (age <20y). However, risk factors for mortality among adults age 20 and older involved multiple domains of demographics (eg, metropolitan residence), injury-related measures (eg, falls versus vehicular incidents), and comorbidity (eg, > or =3 comorbid health conditions versus none). CONCLUSIONS: TBI confers an increased risk of mortality in the months and years after hospital discharge. Although life expectancy is reduced across the population, the excess in mortality lessens as time since injury increases. Specific risk factors (eg, high injury severity, poor general health) pose an especially high threat to survival and should prompt an increased vigilance of health status, especially among younger patients. SN - 1532-821X UR - https://www.unboundmedicine.com/medline/citation/20103393/Mortality_after_discharge_from_acute_care_hospitalization_with_traumatic_brain_injury:_a_population_based_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-9993(09)00766-7 DB - PRIME DP - Unbound Medicine ER -