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 8,084persons 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 were 6.9 times more likely to die, with an average LE reduction of 12.2 years. Relative to the US general population matched for age, gender and race/ethnicity, these non-command following individuals were over 4 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 to the US general population, and compared to all individuals with moderate to severe TBI receiving inpatient rehabilitation. Respiratory causes of death predominate compared to the general population.

The Impact of Medical Complications in Predicting the Rehabilitation Outcome of Patients With Disorders of Consciousness After Severe Traumatic Brain Injury

“…As already explained by Estraneo et al (2018), these are most often caused by pulmonary infections, related to the presence of tracheostomy and systemic immune suppression. This kind of complication has shown to be the main cause of death in individuals with moderate or severe TBI (Greenwald et al, 2015). A study of 224 severe TBI patients admitted to ICU found that the most common cause of death is respiratory infections or severe respiratory failure.…”

Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge

“…This mortality rate is consistent with that in large cohorts in the pediatric traumatic literature. 3,12,30,32 After protocol implementation, the mortality rate dropped to 21%, and the rate of discharge home increased dramatically to 69%. This is a significant improvement and demonstrates the possibility of improving short-term outcomes by standardizing PICU care for pediatric patients with severe TBI.…”

Chronic impact of traumatic brain injury on outcome and quality of life: a narrative review

“…are more common in young survivors, while in cases older than 45 years medical problems such as pneumonia, sepsis, and neurodegenerative diseases are associated with early deaths. In an American study the risk of dying was 2.2 times more than controls considering moderate to severe TBI who received inpatient rehabilitation, with an average reduction of life expectancy of 6.6 years [ 59 ]. The data were much worse for individuals who were unable to follow commands on admission to rehabilitation: they were 6.9 times more likely to die, with an average life expectancy reduction of 12.2 years.…”

“…This condition may be transient, preceding further recovery, or persist. If repeated accurate assessments confirm unresponsiveness 1 year after injury, a persistent vegetative state is diagnosed [ 59 ]. A high rate of misdiagnosis is reported because of the barriers to communication from the patient and the environment, so that patients with minimal, but present, responses (minimally conscious state) are confused with cases without responsiveness.…”