Pre-injury health status and excess mortality in persons with traumatic brain injury: A decade-long historical cohort study

PREVENTIVE MEDICINE

卷:139

Article

Mollayeva, Tatyana^1,2  Hurst, Mackenzie^1,2  Chan, Vincy^1,2  Escobar, Michael⁴  Sutton, Mitchell^1,2  Colantonio, Angela^1,2,3,4,5,6 

[1] Univ Hlth Network, KITE Toronto Rehabil Inst, 550 Univ Ave,Rm 11-183, Toronto, ON M5G 2A2, Canada

[2] Univ Toronto, Acquired Brain Injury Res Lab, Toronto, ON, Canada

[3] Univ Toronto, Fac Med, Rehabil Sci Inst, Toronto, ON, Canada

[4] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[5] ICES Inst Clin Evaluat Sci, Toronto, ON, Canada

[6] Univ Toronto, Occupat Sci & Occupat Therapy, Toronto, ON, Canada

关键词: Age;    Comorbidity;    Environmental exposures;    Injury severity;    Health services;    Mortality;    Life tables;    Risk;    Sex differences;    Traumatic brain injury;   

DOI  :  10.1016/j.ypmed.2020.106213

来源: Elsevier

【 摘 要 】

An increasing number of patients are able to survive traumatic brain injuries (TBIs) with advanced resuscitation. However, the role of their pre-injury health status in mortality in the following years is not known. Here, we followed 77,088 consecutive patients (59% male) who survived the TBI event in Ontario, Canada for more than a decade, and examined the relationships between their pre-injury health status and mortality rates in excess to the expected mortality calculated using sexand age-specific life tables. There were 5792 deaths over the studied period, 3163 (6.95%) deaths in male and 2629 (8.33%) in female patients. The average excess mortality rate over the follow-up period of 14 years was 1.81 (95% confidence interval = 1.76-1.86). Analyses of follow-up time windows showed different patterns for the average excess rate of mortality following TBI, with the greatest rates observed in year one after injury. Among identified pre-injury comorbidity factors, 33 were associated with excess mortality rates. These rates were comparable between sexes. Additional analyses in the validation dataset confirmed that these findings were unlikely a result of TBI misclassification or unmeasured confounding. Thus, detection and subsequent management of pre-injury health status should be an integral component of any strategy to reduce excess mortality in TBI patients. The complexity of pre-injury comorbidity calls for integration of multidisciplinary health services to meet TBI patients' needs and prevent adverse outcomes.

【 授权许可】

Free