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. 2024 Jul 24;9(1):e001501.
doi: 10.1136/tsaco-2024-001501. eCollection 2024.

Prior traumatic brain injury is a risk factor for in-hospital mortality in moderate to severe traumatic brain injury: a TRACK-TBI cohort study

John K Yue  1 , Leila L Etemad  1 , Mahmoud M Elguindy  1 , Thomas A van Essen  2 , Patrick J Belton  3 , Lindsay D Nelson  4 , Michael A McCrea  4 , Rick J G Vreeburg  2 , Christine J Gotthardt  1 , Joye X Tracey  1 , Bukre C Coskun  1 , Nishanth Krishnan  1 , Cathra Halabi  5 , Shawn R Eagle  6 , Frederick K Korley  7 , Claudia S Robertson  8 , Ann-Christine Duhaime  9 , Gabriela G Satris  1 , Phiroz E Tarapore  1 , Michael C Huang  1 , Debbie Y Madhok  10 , Joseph T Giacino  11 , Pratik Mukherjee  12 , Esther L Yuh  12 , Alex B Valadka  13 , Ava M Puccio  6 , David O Okonkwo  6 , Xiaoying Sun  14 , Sonia Jain  14 , Geoffrey T Manley  1 , Anthony M DiGiorgio  1 ; TRACK-TBI Investigators; Neeraj Badjatia  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Jason Barber  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Yelena G Bodien  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Brian Fabian  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Adam R Ferguson  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Brandon Foreman  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Raquel C Gardner  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Shankar Gopinath  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Ramesh Grandhi  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , J Russell Huie  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , C Dirk Keene  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Hester F Lingsma  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Christine L MacDonald  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Amy J Markowitz  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Randall Merchant  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Laura B Ngwenya  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Richard B Rodgers  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Andrea L C Schneider  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , David M Schnyer  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Sabrina R Taylor  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Nancy R Temkin  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Abel Torres-Espin  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Mary J Vassar  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Kevin K W Wang  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Justin C Wong  1   2   3   4   5   6   7   8   9   10   11   12   13   14 , Ross D Zafonte  1   2   3   4   5   6   7   8   9   10   11   12   13   14
Affiliations

Prior traumatic brain injury is a risk factor for in-hospital mortality in moderate to severe traumatic brain injury: a TRACK-TBI cohort study

John K Yue et al. Trauma Surg Acute Care Open. .

Abstract

Objectives: An estimated 14-23% of patients with traumatic brain injury (TBI) incur multiple lifetime TBIs. The relationship between prior TBI and outcomes in patients with moderate to severe TBI (msTBI) is not well delineated. We examined the associations between prior TBI, in-hospital mortality, and outcomes up to 12 months after injury in a prospective US msTBI cohort.

Methods: Data from hospitalized subjects with Glasgow Coma Scale score of 3-12 were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (enrollment period: 2014-2019). Prior TBI with amnesia or alteration of consciousness was assessed using the Ohio State University TBI Identification Method. Competing risk regressions adjusting for age, sex, psychiatric history, cranial injury and extracranial injury severity examined the associations between prior TBI and in-hospital mortality, with hospital discharged alive as the competing risk. Adjusted HRs (aHR (95% CI)) were reported. Multivariable logistic regressions assessed the associations between prior TBI, mortality, and unfavorable outcome (Glasgow Outcome Scale-Extended score 1-3 (vs. 4-8)) at 3, 6, and 12 months after injury.

Results: Of 405 acute msTBI subjects, 21.5% had prior TBI, which was associated with male sex (87.4% vs. 77.0%, p=0.037) and psychiatric history (34.5% vs. 20.7%, p=0.010). In-hospital mortality was 10.1% (prior TBI: 17.2%, no prior TBI: 8.2%, p=0.025). Competing risk regressions indicated that prior TBI was associated with likelihood of in-hospital mortality (aHR=2.06 (1.01-4.22)), but not with hospital discharged alive. Prior TBI was not associated with mortality or unfavorable outcomes at 3, 6, and 12 months.

Conclusions: After acute msTBI, prior TBI history is independently associated with in-hospital mortality but not with mortality or unfavorable outcomes within 12 months after injury. This selective association underscores the importance of collecting standardized prior TBI history data early after acute hospitalization to inform risk stratification. Prospective validation studies are needed.

Level of evidence: IV.

Trial registration number: NCT02119182.

Keywords: mortality; patient outcome assessment; risk factor; traumatic brain injury.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1. Flow diagram of included subjects from the TRACK-TBI Study. Moderate to severe traumatic brain injury (TBI) was defined as emergency department (ED) arrival Glasgow Coma Scale (GCS) score of 3–12. GCS=Glasgow Coma Scale; TBI=traumatic brain injury; TRACK-TBI=, Transforming Research and Clinical Knowledge in Traumatic Brain Injury.
Figure 2
Figure 2. Estimated cumulative incidence function curves for in-hospital mortality and hospital discharged alive over a given hospital length of stay timeframe for patients with versus without prior traumatic brain injury (TBI) history.
Figure 3
Figure 3. Estimated cumulative incidence function curves for in-hospital mortality and hospital discharged alive over a given hospital length of stay timeframe for patients with versus without prior traumatic brain injury (TBI) history, censoring patients with unfavorable hospital discharge (defined as nursing facility/nursing home, long-term acute care facility, hospice, and transfer to another hospital).
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