Mortality After Discharge From Acute Care Hospitalization With Traumatic Brain Injury: A Population-Based Study

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, ≥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.

Key Words: Brain injuries, Comorbidity, Mortality, Population surveillance, Rehabilitation

a Craig Hospital, Englewood, CO

b Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Denver, CO

c Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Denver, CO

d MSPH/MPH Program, Colorado School of Public Health, University of Colorado Denver, Denver, CO

e Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Denver, CO

f School of Medicine, University of Colorado Denver, Denver, CO

g Colorado Injury Control Research Center, Colorado State University, Fort Collins, CO

h Colorado Department of Public Health and Environment, Denver, CO

i Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, AL

j Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN

Correspondence to Cynthia Harrison-Felix, PhD, Craig Hospital, 3425 S Clarkson St, Englewood, CO 80113

Supported by the Colorado Traumatic Brain Injury Trust Fund Research Program (Colorado Department of Human Services). DiGuiseppi was supported in part by the Centers for Disease Control and Prevention (grant no. R49/CCR811509). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

Reprints are not available from the author.

PII: S0003-9993(09)00766-7

doi:10.1016/j.apmr.2009.08.151

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