Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Nov 10:3:46.
doi: 10.1186/s40560-015-0113-4. eCollection 2015.

Demographic and clinical risk factors associated with hospital mortality after isolated severe traumatic brain injury: a cohort study

Vijay Krishnamoorthy  1 , Monica S Vavilala  2 , Brianna Mills  3 , Ali Rowhani-Rahbar  3
Affiliations

Demographic and clinical risk factors associated with hospital mortality after isolated severe traumatic brain injury: a cohort study

Vijay Krishnamoorthy et al. J Intensive Care. .

Abstract

Background: Traumatic brain injury (TBI) is a major public health problem and a leading cause of death worldwide. A paucity of literature exists on risk factors for mortality in isolated severe TBI, a condition that is distinct from severe TBI in the setting of multisystem trauma. We determined risk factors for in-hospital mortality in this patient population.

Methods: We conducted a retrospective cohort study using data from the National Trauma Databank from 2008-2012 to study all patients admitted with a diagnosis of severe TBI, excluding children, patients with non-isolated TBI, transfers, and hospitalization <48 h. We used multivariable Poisson regression to analyze the association between demographic, clinical, and facility-level characteristics and in-hospital mortality.

Results: A total of 41,590 patients were included in our analysis. The cumulative incidence of in-hospital mortality was 10.2 %. In multivariable analysis, older age (RR 3.92, 95 % CI 3.54-4.34), male gender (RR 1.17, 95 % CI 1.09-1.25), admission hypotension (RR 1.83, 95 % CI 1.61-2.09), the need for mechanical ventilation (RR 4.18, 95 % CI 3.64-4.80), higher injury severity score (RR 1.86, 95 % CI 1.41-2.45), and poor initial neurologic grade (RR 3.06, 95 % CI 2.74-3.43) were associated with a higher risk for mortality.

Conclusions: Admission hypotension and the need for mechanical ventilation were possible modifiable risk factors associated with increased in-hospital mortality following isolated severe TBI. Although risk factors for mortality are similar in isolated and non-isolated TBI, the underlying etiologies for hypotension and respiratory failure are likely different in both conditions and require further exploration.

Keywords: Brain injury; Outcomes; Trauma.

PubMed Disclaimer

References

    1. Rutland-Brown W, Langlois JA, Thomas KE, Xi YL. Incidence of traumatic brain injury in the United States, 2003. J Head Trauma Rehabil. 2006;21(6):544–548. doi: 10.1097/00001199-200611000-00009. - DOI - PubMed
    1. Faul MXL, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002–2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
    1. Piek J, Chesnut RM, Marshall LF, van Berkum-Clark M, Klauber MR, Blunt BA, et al. Extracranial complications of severe head injury. J Neurosurg. 1992;77(6):901–907. doi: 10.3171/jns.1992.77.6.0901. - DOI - PubMed
    1. Zhang J, Jiang R, Liu L, Watkins T, Zhang F, Dong JF. Traumatic brain injury-associated coagulopathy. J Neurotrauma. 2012;29(17):2597–2605. doi: 10.1089/neu.2012.2348. - DOI - PMC - PubMed
    1. Almahmoud K, Namas RA, Zaaqoq AM, Abdul-Malak O, Namas R, Zamora R, et al. Prehospital hypotension is associated with altered inflammation dynamics and worse outcomes following blunt trauma in humans. Crit Care Med. 2015;43(7):1395–404. doi: 10.1097/CCM.0000000000000964. - DOI - PubMed

LinkOut - more resources