Article

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, > or =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.
CI - Copyright (c) 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS