Mortality Over Four Decades After Traumatic Brain Injury Rehabilitation: A Retrospective Cohort Study

Abstract 

Harrison-Felix CL, Whiteneck GG, Jha A, DeVivo MJ, Hammond FM, Hart DM. Mortality over four decades after traumatic brain injury rehabilitation: a retrospective cohort study.

Objective

To investigate mortality, life expectancy, risk factors for death, and causes of death in persons with traumatic brain injury (TBI).

Design

Retrospective cohort study.

Setting

Used data from an inpatient rehabilitation facility, the Social Security Death Index, death certificates, and the U.S. population age-race-sex–specific and cause-specific mortality rates.

Participants

Persons with TBI (N=1678) surviving to their first anniversary of injury admitted to rehabilitation from an acute care hospital within 1 year of injury between 1961 and 2002.

Interventions

Not applicable.

Main Outcome Measures

Vital status, standardized mortality ratio, life expectancy, cause of death.

Results

Persons with TBI were 1.5 times more likely to die than persons in the general population of similar age, sex, and race, resulting in an estimated average life expectancy reduction of 4 years. Within the TBI population, the strongest independent risk factors for death after 1 year postinjury were being older, being male, having less education, having a longer hospitalization, having an earlier year of injury, and being in a vegetative state at rehabilitation discharge. After 1 year postinjury, persons with TBI were 49 times more likely to die of aspiration pneumonia, 22 times more likely to die of seizures, 4 times more likely to die of pneumonia, 3 times more likely to commit suicide, and 2.5 times more likely to die of digestive conditions than persons in the general population of similar age, sex, and race.

Conclusions

This study demonstrated life expectancy after TBI rehabilitation is reduced and associated with specific risk factors and causes of death.

Key Words: Brain injuries, Cause of death, Life expectancy, Mortality, Rehabilitation

List of Abbreviations: CI, confidence interval, GOS, Glasgow Outcome Scale, ICD-9-CM, International Classification of Diseases–9th Revision–Clinical Modifications, SMR, standardized mortality ratio, SSDI, Social Security Death Index, TBI, traumatic brain injury