Risk of posthospitalization mortality among persons with traumatic brain injury, South Carolina 1999-2001.
ABSTRACT Traumatic brain injury (TBI) negatively impacts long-term survival. However, little is known about the likelihood of death within the first year following hospital discharge. This study examined mortality among a representative sample of 3679 persons within 1 year of being discharged from any of 62 acute care hospitals in South Carolina following TBI and identified the factors associated with early death using a multivariable Cox proportional hazards model. The mortality experience of the cohort was also compared with that of the general population by using standardized mortality ratios for selected causes of death by age, adjusted for race and sex.
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ABSTRACT: This study characterized life expectancy after traumatic brain injury (TBI). The TBI Model Systems (TBIMS) National Database (NDB) was weighted to represent those 16 years of age and older completing inpatient rehabilitation for TBI in the United States (US) between 2001 and 2010. Analyses included Standardized Mortality Ratios (SMRs), Cox regression, and life expectancy. The US mortality rates by age, sex, race, and cause of death for 2005 and 2010 were used for comparison purposes. Results indicated a total of 1,325 deaths occurred in the weighted cohort of 6,913 individuals. Individuals with TBI were 2.23 times more likely to die than individuals of comparable age, sex, and race in the general population, with a reduced average life expectancy of nine years. Independent risk factors for death were: older age, male gender, less-than-high school education, previously married at injury, not employed at injury, more recent year of injury, fall-related TBI, not discharged home after rehabilitation, less functional independence, and greater disability. Individuals with TBI were at greatest risk of death due to seizures, accidental poisonings, sepsis, aspiration pneumonia, respiratory, mental/behavioral or nervous system conditions and other external causes of injury and poisoning compared to individuals in the general population of similar age, gender, and race. This study confirms prior life expectancy study findings, and provides evidence that the TBIMS NDB is representative of the larger population of adults receiving inpatient rehabilitation for TBI in the US. There is an increased risk of death for individuals with TBI requiring inpatient rehabilitation.Journal of Neurotrauma 07/2014; DOI:10.1089/neu.2014.3353 · 3.97 Impact Factor
Topics in Geriatric Rehabilitation 01/2014; 30(3):230-236. DOI:10.1097/TGR.0000000000000027 · 0.14 Impact Factor
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ABSTRACT: Background: The reported incidence of concurrent traumatic brain (TBI) and spine or spinal cord injuries (SCI) is poorly defined, with widely variable literature rates from 16 to 74%. Objectives: To define the incidence of concurrent TB! and SCI, and compare the incidence over a twenty-year time period. Methods: To define the longitudinal incidence and concurrent rate of TBI and SCI via a retrospective review of the Nationwide Inpatient Sample (NIS) database over a twenty year period. Results: Over the study period, the incidence of TBI declined from 143 patients/100k admissions to 95 patients/100k. However, there was a concurrent increase in SCI from 61 patients/100k admissions to 75 patients/100k admissions (P <0.0001). Regional variations in SCI trends were noted, with specific regions demonstrating an increasing trend. Cervical fractures had the greatest increase by nearly a three-fold rise (1988: 4562-2008: 12,418). There was an increase in the incidence of TBI among SCI admission from 3.7% (1988) to 12.5% (2008) (OR = 1.067 per year; 95% Cl = 1.065-1.069 per year; P <0.0001). Concurrently, SCI patients had an increase in TBI (9.1% (1988)-15.9% (2008) (OR = 1.038 per year (95% Cl 1.036-1.040; P < 0.001))). Conclusion: A retrospective review of the NIS demonstrates a rising trend in the incidence of concurrent TBI and SCI. More investigative work is necessary to examine causative factors for this trend.Clinical Neurology and Neurosurgery 06/2014; 123C:174-180. DOI:10.1016/j.clineuro.2014.05.013 · 1.25 Impact Factor