Long-term survival after traumatic brain injury: a population-based analysis.
This population-based retrospective cohort study identified all Olmsted County, MN residents with any diagnosis indicative of potential traumatic brain injury (TBI) during the years 1985 to 2000. The complete community-based medical records of a random sample (n = 7,175) were reviewed to confirm and characterize the event, and to determine vital status through 2002. The review identified 1,448 confirmed incident cases; 164 (11%) were moderate to severe; 1,284 were mild. The estimated 30-day case fatality rate was 29% for moderate to severe cases and 0.2% for mild cases. Comparison of observed mortality over the full period of follow-up with that expected revealed a risk ratio (95% CI) of 5.29 (4.11-6.71) for moderate to severe cases and 1.33 (1.05-1.65) for mild cases. Proportional hazards modeling showed the adjusted hazard of all-cause mortality for moderate to severe cases relative to mild cases was 5.18 (3.65-7.3) within six months of the event and 1.04 (0.57-1.88) for the remaining follow-up period. This analysis indicates that persons who experience mild TBI exhibit a small but statistically significant reduction in long-term survival compared to the general population. The case fatality rate for persons with moderate to severe TBI is very high, but among six-month survivors, long-term survival is similar to that for persons with mild TBI.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA. brown.allen@mayo.edu
Allen W
AW
Brown
Cynthia L
CL
Leibson
James F
JF
Malec
Patricia K
PK
Perkins
Nancy N
NN
Diehl
Dirk R
DR
Larson
D000328:Adult; D001930:Brain Injuries / Q000401:mortality / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008136:Longevity; D008297:Male; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D015599:Trauma Severity Indices