title: Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study.
abstract: Severe traumatic brain injury (TBI) has been associated with increased mortality. This study characterizes long-term mortality, life expectancy, causes of death, and risk factors for death among patients admitted within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Programs (TBIMS) who lack command following at the time of admission for inpatient TBI rehabilitation. Of the 8084 persons enrolled from 1988 and 2009, 387 from 20 centers met study criteria. Individuals with moderate to severe TBI who received inpatient rehabilitation were 2.2 times more likely to die than individuals in the U.S. general population of similar age, gender, and race, with an average life expectancy (LE) reduction of 6.6 years. The subset of individuals who were unable to follow commands on admission to rehabilitation was 6.9 times more likely to die, with an average LE reduction of 12.2 years. Relative to the U.S. general population matched for age, gender, and race/ethnicity, these non-command following individuals were more than four times more likely to die of circulatory conditions, 44 times more likely to die of pneumonia, and 38 times more likely to die of aspiration pneumonia. The subset of individuals with TBI who are unable to follow commands upon admission to inpatient rehabilitation are at a significantly increased risk of death when compared with the U.S. general population and compared with all individuals with moderate to severe TBI receiving inpatient rehabilitation. Respiratory causes of death predominate, compared with the general population.
authors.affiliation: 1 JFK Johnson Rehabilitation Center for Head Injuries, Rutgers Robert Wood Johnson Medical School , Edison, New Jersey.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Greenwald
authors.affiliation: 2 Indiana University School of Medicine , Indianapolis, Indiana.
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.affiliation: 3 Craig Hospital , Englewood, Colorado.|4 Department of Physical Medicine and Rehabilitation, University of Colorado Denver , Aurora, Colorado.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Harrison-Felix
authors.affiliation: 5 Department of Mental Health and Behavioral Sciences, James A. Haley Veterans Hospital , Tampa, Florida.
authors.forename: Risa
authors.initials: R
authors.lastname: Nakase-Richardson
authors.affiliation: 6 Psychology Services, VA Palo Alto Health Care System , Palo Alto, California.
authors.forename: Laura L S
authors.initials: LL
authors.lastname: Howe
authors.affiliation: 7 Department of Education and Behavioral Sciences, University of Northern Colorado , Greely, Colorado.
authors.forename: Scott
authors.initials: S
authors.lastname: Kreider
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000401:mortality* / Q000534:rehabilitation; D002423:Cause of Death; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States
keywords: brain injuries; brain injury; chronic; disorder of consciousness; epidemiology; life expectancy; mortality; rehabilitation