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

被引:6
作者
Mollayeva, Tatyana [1 ,2 ]
Hurst, Mackenzie [1 ,2 ]
Chan, Vincy [1 ,2 ]
Escobar, Michael [4 ]
Sutton, Mitchell [1 ,2 ]
Colantonio, Angela [1 ,2 ,3 ,4 ,5 ,6 ]
机构
[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
基金
美国国家卫生研究院;
关键词
Age; Comorbidity; Environmental exposures; Injury severity; Health services; Mortality; Life tables; Risk; Sex differences; Traumatic brain injury; AFTER-DISCHARGE; HEAD-INJURY; EPIDEMIOLOGY; CARE; AGE; SEVERITY; CLASSIFICATION; CONSEQUENCES; MORBIDITY; ALCOHOL;
D O I
10.1016/j.ypmed.2020.106213
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
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.
引用
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页数:10
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