Trends in mortality after intensive care of patients with traumatic brain injury in Finland from 2003 to 2019: a Finnish Intensive Care Consortium study

Abstract

Background Several studies have suggested no change in the outcome of patients with traumatic brain injury (TBI) treated in intensive care units (ICUs). This is mainly due to the shift in TBI epidemiology toward older and sicker patients. In Finland, the share of the population aged 65 years and over has increased the most in Europe during the last decade. We aimed to assess changes in 12-month and hospital mortality of patients with TBI treated in the ICU in Finland. Methods We used a national benchmarking ICU database (Finnish Intensive Care Consortium) to study adult patients who had been treated for TBI in four tertiary ICUs in Finland during 2003–2019. We divided admission years into quartiles and used multivariable logistic regression analysis, adjusted for case-mix, to assess the association between admission year and mortality. Results A total of 4535 patients were included. Between 2003–2007 and 2016–2019, the patient median age increased from 54 to 62 years, the share of patients having significant comorbidity increased from 8 to 11%, and patients being dependent on help in activities of daily living increased from 7 to 15%. Unadjusted hospital and 12-month mortality decreased from 18 and 31% to 10% and 23%, respectively. After adjusting for case-mix, a reduction in odds of 12-month and hospital mortality was seen in patients with severe TBI, intracranial pressure monitored patients, and mechanically ventilated patients. Despite a reduction in hospital mortality, 12-month mortality remained unchanged in patients aged ≥ 70 years. Conclusion A change in the demographics of ICU-treated patients with TBI care is evident. The outcome of younger patients with severe TBI appears to improve, whereas long-term mortality of elderly patients with less severe TBI has not improved. This has ramifications for further efforts to improve TBI care, especially among the elderly.

Predictors of Mortality Due to Severe Traumatic Brain Injury: a Prospective Observational Cohort Study With 1-year Analyses

“…This nding was also previously reported by the literature in both LMICs and HICs [25,[32][33]. Furthermore, GCS at admission, another widely used predictor of in-hospital mortality, [12,31,34], surprisingly, was not associated with outcome in this study. Most patients' scores in the GCS at hospital admission ranged between 3-5, and even though some individuals had higher GCS scores at emergency, as part of a severe TBI sample, at some point they evolved to loss of consciousness and lower scores.…”

“…In our study, the in-hospital mortality rate was 55%, signi cantly higher than the hospital mortality rates of 19.1-33.2% reported in other studies conducted in Brazil [5, 9-12], and even higher when compared to mortality rates in North America (13.3%), Europe (25.5%), and China 20.0% [23][24][25]. Interestingly, the mortality rate 1 year after discharge (15.1%) was lower than the mortality rate reported in other long-term studies in China (30%) [26], Europe (30%) [27] and India (44%) [6]. Therefore, the mortality rate is substantially high in the setting of this study, possibly explained by the severity of the injuries associated with limited diagnosis capabilities of intracranial injuries, delayed or inadequate initial care, lack of monitoring, and specialized treatment.…”

Prehospital Predictors for Urgent Neurosurgical Intervention in the Head Trauma Patient: A 2-Year Multicenter Retrospective Study

“…The authors focused on the most commonly reported patient's complaints and on abnormal physical examination findings–apart from evident external symptoms of head trauma and a low GCS score–that may raise suspicion of head trauma requiring urgent neurosurgical intervention. Our analysis revealed few interesting insights, a lot corresponds to the data from most European countries, where a shift in the age of head trauma patients from young patients to those >65 years old has been observed in recent years [ 10 ]. In contrast with a paper by Bossers et al [ 7 ], the most common cause of injuries in our study was falls on the same level.…”

Prolonged duration of post-traumatic amnesia: A sensitive classification for predicting cognitive outcomes in children recovering from traumatic brain injury

“…In the current study, three PTA duration groups were assembled out of a cluster analysis distinguishing between different attention and EF capabilities at the initial stages of recovery rehabilitation. The additional three PTA duration groups suggested here are complementary to Russell’s scheme classification (Russell & Smith, 1961) becoming increasingly significant, as the number of patients who survive msTBI is increasing (Stein et al, (2010), especially among the younger patients (Luostarinen et al, 2022). Further research can use the PTA duration groups to evaluate the association of these markers with long-term cognitive outcomes (i.e., 1 year following pediatric TBI) and predict patterns of recovery.…”