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Long-term survival after traumatic brain injury: a population-based analysis controlled for nonhead trauma.

ABSTRACT: To examine the contribution of co-occurring nonhead injuries to hazard of death after traumatic brain injury (TBI).A random sample of Olmsted County, Minnesota, residents with confirmed TBI from 1987 through 1999 was identified.Each case was assigned an age- and sex-matched, non-TBI "regular control" from the population. For "special cases" with accompanying nonhead injuries, 2 matched "special controls" with nonhead injuries of similar severity were assigned.Vital status was followed from baseline (ie, injury date for cases, comparable dates for controls) through 2008. Cases were compared first with regular controls and second with regular or special controls, depending on case type.In total, 1257 cases were identified (including 221 special cases). For both cases versus regular controls and cases versus regular or special controls, the hazard ratio was increased from baseline to 6 months (10.82 [2.86-40.89] and 7.13 [3.10-16.39], respectively) and from baseline through study end (2.92 [1.74-4.91] and 1.48 [1.09-2.02], respectively). Among 6-month survivors, the hazard ratio was increased for cases versus regular controls (1.43 [1.06-2.15]) but not for cases versus regular or special controls (1.05 [0.80-1.38]).Among 6-month survivors, accounting for nonhead injuries resulted in a nonsignificant effect of TBI on long-term mortality.

SUBMITTER: Brown AW

PROVIDER: S-EPMC4321729 | biostudies-literature | 2014 Jan-Feb

REPOSITORIES: biostudies-literature

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Long-term survival after traumatic brain injury: a population-based analysis controlled for nonhead trauma.

Brown Allen W AW Leibson Cynthia L CL Mandrekar Jay J Ransom Jeanine E JE Malec James F JF

The Journal of head trauma rehabilitation 20140101 1

<h4>Objective</h4>To examine the contribution of co-occurring nonhead injuries to hazard of death after traumatic brain injury (TBI).<h4>Participants</h4>A random sample of Olmsted County, Minnesota, residents with confirmed TBI from 1987 through 1999 was identified.<h4>Design</h4>Each case was assigned an age- and sex-matched, non-TBI "regular control" from the population. For "special cases" with accompanying nonhead injuries, 2 matched "special controls" with nonhead injuries of similar sever ...[more]

PMID: 23381021

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Project description:To determine the risk-adjusted mortality of intentionally injured patients within 7 to 9 years postinjury, compared with unintentionally injured patients.Violent injury contributes significantly to trauma mortality in the United States. Homicide is the second leading killer of American youth, aged 15 to 24 years. Long-term survival among intentionally injured patients has not been well studied. It is also unknown whether intentionally injured patients have worse long-term survival compared with unintentionally or accidentally injured patients with equivalent injuries.Adult trauma patients admitted for 24 hours or more and discharged alive from the Johns Hopkins Hospital from January 1, 1998, to December 31, 2000, were included. The primary outcome was mortality within 7 to 9 years postinjury. Long-term patient survival was determined using the National Death Index. The association between injury intentionality and mortality was investigated using a Cox proportional hazard regression model, adjusted for confounders such as injury severity and patient race, socioeconomic status, and comorbid conditions. Overall differences in survival between those with intentional versus unintentional injury were also determined by comparing adjusted Kaplan-Meier survival curves.A total of 2062 patients met inclusion criteria. Of these, 56.4% were intentionally injured and 43.6% were unintentionally injured. Compared with unintentionally injured patients, intentionally injured patients were younger and more often male and from a zip code with low median household income. Approximately 15% of all patients had died within 7 to 9 years of follow-up. Older age and presence of comorbidities were associated with this outcome; however, intentional injury was not found to be significantly associated with long-term mortality rates. There was also no significant difference in survival curves between groups; intentionally injured patients were much more likely to die of a subsequent injury, whereas those with unintentional injury commonly died of noninjury causes.There was no significant difference in mortality between intentionally injured and unintentionally injured patients within 7 to 9 years postinjury. These results confirm the long-term effectiveness of lifesaving trauma care for those with intentional injury. However, given that patients with intentional injuries were more likely to suffer a subsequent violent death, interventions focused on breaking the cycle of violence are needed.

Dataset Information

Long-term survival after traumatic brain injury: a population-based analysis controlled for nonhead trauma.

Publications

Long-term survival after traumatic brain injury: a population-based analysis controlled for nonhead trauma.

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