Dynamic predictors of in-hospital and 3-year mortality after traumatic brain injury: A retrospective cohort study - 16/03/23

Doi : 10.1016/j.amjsurg.2022.10.003

Laura D. Wilson ^a, Amelia W. Maiga ^b,^c, Sarah Lombardo ^c,^d, Mina F. Nordness ^b,^c, Diane N. Haddad ^b,^c,^e, Shayan Rakhit ^b,^c, Laney F. Smith ^b,^f, Erika L. Rivera ^b,^c, Madison R. Cook ^b,^c,^g,ⁱ, Jennifer L. Thompson ^b,^h,^j, Rameela Raman ^b,^h, Mayur B. Patel ^b,^c,^k,^⁎
^a Oxley College of Health Sciences, Communication Sciences and Disorders, The University of Tulsa, 800 S Tucker Dr, Tulsa, OK, 74104, USA
^b Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA
^c Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, 1211 21st Avenue South, Suite 404, Nashville, TN, 37212, USA
^d Section of Acute Care Surgery, Division of General Surgery, Department of Surgery, University of Utah Health, 30 N 1900 E, Salt Lake City, UT, 84132, USA
^e The Trauma Center at Penn, 51 North 39th ST, MOB Suite 120, Philadelphia, PA, 19104, USA
^f Georgetown Lombardi Comprehensive Cancer Center, 3800 Reservoir Rd, NW., Washington, D.C., 20057, USA
^g Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA
^h Department of Biostatistics, Vanderbilt University Medical Center, Room 11133B, 2525 West End Avenue Nashville, TN, 37203, USA
ⁱ Department of Surgery, Temple University Hospital, 3401 N. Broad Street, Parkinson Pavilion, Suite 400, Philadelphia, PA, 19140, USA
^j Devoted Health, 221 Crescent St #202, Waltham, MA, 02453, USA
^k Vanderbilt University Medical Center, Geriatric Research Education and Clinical Center, Surgical Services, Tennessee Valley Healthcare System, USA

^∗Corresponding author. Critical Illness, Brain dysfunction, & Survivorship Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA.Critical Illness, Brain dysfunction, & Survivorship CenterSuite 450, 4th Floor, 2525 West End Avenue NashvilleTN37203USA

Abstract

Background

Mortality risks after Traumatic Brain Injury (TBI) are understudied in critical illness. We sought to identify risks of mortality in critically ill patients with TBI using time-varying covariates.

Methods

This single-center, six-year (2006–2012), retrospective cohort study measured demographics, injury characteristics, and daily data of acute TBI patients in the Intensive Care Unit (ICU). Time-varying Cox proportional hazards models assessed in-hospital and 3-year mortality.

Results

Post-TBI ICU patients (n = 2664) experienced 20% in-hospital mortality (n = 529) and 27% (n = 706) 3-year mortality. Glasgow Coma Scale motor subscore (hazard ratio (HR) 0.58, p < 0.001), pupil reactivity (HR 3.17, p < 0.001), minimum glucose (HR 1.44, p < 0.001), mSOFA score (HR 1.81, p < 0.001), coma (HR 2.26, p < 0.001), and benzodiazepines (HR 1.38, p < 0.001) were associated with in-hospital mortality. At three years, public insurance (HR 1.78, p = 0.011) and discharge disposition (HR 4.48, p < 0.001) were associated with death.

Conclusions

Time-varying characteristics influenced in-hospital mortality post-TBI. Socioeconomic factors primarily affect three-year mortality.

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Highlights

•	Dynamic factors affect mortality in ICU patients with traumatic brain injury (TBI).
•	Protective ICU factors post-TBI include certain medications and blood products.
•	Long-term post-TBI mortality is influenced by socioeconomic factors.

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Keywords : Traumatic brain injury, Mortality, Mental status, Predictors, Critical illness

Plan

Introduction

Materials and methods

Statistical models

Results

In-hospital mortality

Three-year mortality

Discussion

Conclusions

Authors' contributions

Funding

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Vol 225 - N° 4

P. 781-786 - avril 2023 Retour au numéro

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Dynamic predictors of in-hospital and 3-year mortality after traumatic brain injury: A retrospective cohort study - 16/03/23

Abstract

Background

Methods

Results

Conclusions

Highlights

Plan

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