title: Association between the Osteoporosis Self-Assessment Tool for Asians Score and Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury: A Propensity Score-Matched Analysis.
abstract: Background:The purpose of this study was to use a propensity score-matched analysis to investigate the association between the Osteoporosis Self-Assessment Tool for Asians (OSTA) scores and clinical outcomes of patients with isolated moderate and severe traumatic brain injury (TBI).Methods:The study population comprised 7855 patients aged ≥40 years who were hospitalized for treatment of isolated moderate and severe TBI (an Abbreviated Injury Scale (AIS) ≥3 points only in the head and not in other regions of the body) between 1 January 2009 and 31 December 2014. Patients were categorized as high-risk (OSTA score < -4;n= 849), medium-risk (-4 ≤ OSTA score ≤ -1;n= 1647), or low-risk (OSTA score > -1;n= 5359). Two-sided Pearson's chi-squared, or Fisher's exact tests were used to compare categorical data. Unpaired Student'st-test and Mann-Whitney U test were performed to analyze normally and non-normally distributed continuous data, respectively. Propensity score-matching in a 1:1 ratio was performed using NCSS software, with adjustment for covariates.Results:Compared to low-risk patients, high- and medium-risk patients were significantly older and injured more severely. The high- and medium-risk patients had significantly higher mortality rates, longer hospital length of stay, and a higher proportion of admission to the intensive care unit than low-risk patients. Analysis of propensity score-matched patients with adjusted covariates, including gender, co-morbidity, blood alcohol concentration level, Glasgow Coma Scale score, and Injury Severity Score revealed that high- and medium-risk patients still had a 2.4-fold (odds ratio (OR), 2.4; 95% confidence interval (CI), 1.39-4.15;p= 0.001) and 1.8-fold (OR, 1.8; 95% CI, 1.19-2.86;p= 0.005) higher mortality, respectively, than low-risk patients. However, further addition of age as a covariate for the propensity score-matching demonstrated that there was no significant difference between high-risk and low-risk patients or between medium-risk and low-risk patients, implying that older age may contribute to the significantly higher mortality associated with a lower OSTA score.Conclusions:Older age may be able to explain the association of lower OSTA score and higher mortality rates in patients with isolated moderate and severe TBI.
authors.affiliation: Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan. ersh2127@cloud.cgmh.org.tw.|Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan. ersh2127@cloud.cgmh.org.tw.
authors.forename: Cheng-Shyuan
authors.initials: CS
authors.lastname: Rau
authors.affiliation: Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan. bow110470@gmail.com.|Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan. bow110470@gmail.com.
authors.forename: Pao-Jen
authors.initials: PJ
authors.lastname: Kuo
authors.affiliation: Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan. shaochunwu@gmail.com.|Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan. shaochunwu@gmail.com.
authors.forename: Shao-Chun
authors.initials: SC
authors.lastname: Wu
authors.affiliation: Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan. libe320@yahoo.com.tw.|Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan. libe320@yahoo.com.tw.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan. sylvia19870714@hotmail.com.|Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan. sylvia19870714@hotmail.com.
authors.forename: Hsiao-Yun
authors.initials: HY
authors.lastname: Hsieh
authors.affiliation: Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan. m93chinghua@gmail.com.|Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan. m93chinghua@gmail.com.
authors.forename: Ching-Hua
authors.initials: CH
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D044466:Asian People; D000067401:Blood Alcohol Content; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010024:Osteoporosis / Q000453:epidemiology*; D057216:Propensity Score; D012307:Risk Factors; D012647:Self-Assessment; D012737:Sex Factors; D015599:Trauma Severity Indices
chemical_list: D000067401:Blood Alcohol Content
keywords: Osteoporosis Self-Assessment Tool for Asians (OSTA); injury severity score (ISS); mortality; osteoporosis; traumatic brain injury (TBI)