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Orso D, Furlanis G, Romanelli A, Gheller F, Tecchiolli M, Cominotto F. Risk Factors Analysis for 90-Day Mortality of Adult Patients with Mild Traumatic Brain Injury in an Italian Emergency Department. Geriatrics (Basel) 2024; 9:23. [PMID: 38525740 PMCID: PMC10961819 DOI: 10.3390/geriatrics9020023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose: The most prominent risk factors for mortality after mild traumatic brain injury (TBI) have not been established. This study aimed to establish risk factors related to 90-day mortality after a traumatic event. Methods: A retrospective cohort study on adult patients entering the Emergency Department of the University Hospital of Trieste for mild TBI from 1 January 2020 to 31 December 2020 was conducted. Results: The final population was 1221 patients (median age of 78 years). The 90-day mortality rate was 7% (90 patients). In the Cox regression model (likelihood ratio 110.9; p < 2 × 10-16), the variables that significantly correlated to 90-day mortality were age (less than 75 years old is a protective factor, HR 0.29 [95%CI 0.16-0.54]; p < 0.001); chronic liver disease (HR 4.59 [95%CI 2.56-8.24], p < 0.001); cognitive impairment (HR 2.76 [95%CI 1.78-4.27], p < 0.001); intracerebral haemorrhage (HR 15.38 [95%CI 6.13-38.63], p < 0.001); and hospitalization (HR 2.56 [95%CI 1.67-3.92], p < 0.001). Cardiovascular disease (47% vs. 11%; p < 0.001) and cognitive impairment (36% vs. 10%; p < 0.001) were more prevalent in patients over 75 years of age than the rest of the population. Conclusions: In our cohort of patients with mild TBI, 90-day mortality was low but not negligible. The risk factors associated with 90-day mortality included age, history of chronic liver disease, and cognitive impairment, as well as evidence of intracerebral hemorrhage and hospitalization. The mortality of the sub-population of older patients was likely to be linked to cardiovascular comorbidities and neurodegenerative diseases.
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Affiliation(s)
- Daniele Orso
- Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Via Pozzuolo 330, 33100 Udine, Italy
| | - Giulia Furlanis
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Alice Romanelli
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Federica Gheller
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Marzia Tecchiolli
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Franco Cominotto
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
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Wilson LD, Maiga AW, Lombardo S, Nordness MF, Haddad DN, Rakhit S, Smith LF, Rivera EL, Cook MR, Thompson JL, Raman R, Patel MB. Dynamic predictors of in-hospital and 3-year mortality after traumatic brain injury: A retrospective cohort study. Am J Surg 2023; 225:781-786. [PMID: 36372578 PMCID: PMC10750767 DOI: 10.1016/j.amjsurg.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Mortality risks after Traumatic Brain Injury (TBI) are understudied in critical illness. We sought to identify risks of mortality in critically ill patients with TBI using time-varying covariates. METHODS This single-center, six-year (2006-2012), retrospective cohort study measured demographics, injury characteristics, and daily data of acute TBI patients in the Intensive Care Unit (ICU). Time-varying Cox proportional hazards models assessed in-hospital and 3-year mortality. RESULTS Post-TBI ICU patients (n = 2664) experienced 20% in-hospital mortality (n = 529) and 27% (n = 706) 3-year mortality. Glasgow Coma Scale motor subscore (hazard ratio (HR) 0.58, p < 0.001), pupil reactivity (HR 3.17, p < 0.001), minimum glucose (HR 1.44, p < 0.001), mSOFA score (HR 1.81, p < 0.001), coma (HR 2.26, p < 0.001), and benzodiazepines (HR 1.38, p < 0.001) were associated with in-hospital mortality. At three years, public insurance (HR 1.78, p = 0.011) and discharge disposition (HR 4.48, p < 0.001) were associated with death. CONCLUSIONS Time-varying characteristics influenced in-hospital mortality post-TBI. Socioeconomic factors primarily affect three-year mortality.
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Affiliation(s)
- Laura D Wilson
- Oxley College of Health Sciences, Communication Sciences and Disorders, The University of Tulsa, 800 S Tucker Dr, Tulsa, OK, 74104, USA
| | - Amelia W Maiga
- Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, 1211 21st Avenue South, Suite 404, Nashville, TN, 37212, USA
| | - Sarah Lombardo
- Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, 1211 21st Avenue South, Suite 404, Nashville, TN, 37212, USA; Section of Acute Care Surgery, Division of General Surgery, Department of Surgery, University of Utah Health, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Mina F Nordness
- Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, 1211 21st Avenue South, Suite 404, Nashville, TN, 37212, USA
| | - Diane N Haddad
- Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, 1211 21st Avenue South, Suite 404, Nashville, TN, 37212, USA; The Trauma Center at Penn, 51 North 39th ST, MOB Suite 120, Philadelphia, PA, 19104, USA
| | - Shayan Rakhit
- Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, 1211 21st Avenue South, Suite 404, Nashville, TN, 37212, USA
| | - Laney F Smith
- Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Georgetown Lombardi Comprehensive Cancer Center, 3800 Reservoir Rd, NW., Washington, D.C., 20057, USA
| | - Erika L Rivera
- Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, 1211 21st Avenue South, Suite 404, Nashville, TN, 37212, USA
| | - Madison R Cook
- Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, 1211 21st Avenue South, Suite 404, Nashville, TN, 37212, USA; Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA; Department of Surgery, Temple University Hospital, 3401 N. Broad Street, Parkinson Pavilion, Suite 400, Philadelphia, PA, 19140, USA
| | - Jennifer L Thompson
- Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Department of Biostatistics, Vanderbilt University Medical Center, Room 11133B, 2525 West End Avenue Nashville, TN, 37203, USA; Devoted Health, 221 Crescent St #202, Waltham, MA, 02453, USA
| | - Rameela Raman
- Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Department of Biostatistics, Vanderbilt University Medical Center, Room 11133B, 2525 West End Avenue Nashville, TN, 37203, USA
| | - Mayur B Patel
- Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, 1211 21st Avenue South, Suite 404, Nashville, TN, 37212, USA; Vanderbilt University Medical Center, Geriatric Research Education and Clinical Center, Surgical Services, Tennessee Valley Healthcare System, USA.
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Vaajala M, Kuitunen I, Nyrhi L, Ponkilainen V, Kekki M, Luoto T, Mattila VM. Pregnancy and delivery after traumatic brain injury: a nationwide population-based cohort study in Finland. J Matern Fetal Neonatal Med 2022; 35:9709-9716. [PMID: 35282782 DOI: 10.1080/14767058.2022.2050899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Few studies have assessed pregnancies and deliveries after traumatic brain injury (TBI). We report the incidence of TBIs and TBI-related surgeries in fertile-aged females and investigate subsequent pregnancy outcomes. METHODS All fertile-aged (15-49) women with TBI diagnosis during our study period (1998-2018) were retrieved from the Care Register for Health Care and combined with data from the National Medical Birth Register. TBIs were categorized into three subgroups based on the length of the hospitalization period and the need for neurosurgery. Logistic regression was used to analyze preterm deliveries, cesarean sections (CS) and neonatal health. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). RESULTS The incidence of TBIs increased from 103 per 100 000 person-years in 1998 to 257 per 100 000 (149.5%) in 2018. The incidence of TBI-related surgeries remained stable during our study period. The rate of preterm deliveries was 5.6% in the TBI group and 3.0% in the control group (AOR 1.23, CI 1.17-1.28). The CS rate in the TBI group was 19.2% and 15.9% in the control group (AOR 1.23, CI 1.18-1.29). The use of labor analgesia was higher among women with previous TBI. The rate of neonates requiring intensive care in the TBI group was 13.1% and 9.9% in the control group (AOR 1.30, CI 1.24-1.37). CONCLUSION The incidence of TBI hospitalizations increased during our study period, whereas the number of surgically treated TBI remained stable. Preterm deliveries, CS, instrumental vaginal deliveries and labor analgesia were more prevalent in women with previous TBI. Furthermore, more neonates required intensive care in this group. Therefore, a history of TBI should be acknowledged as a possible factor affecting the delivery and health of the neonate.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland.,Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Lauri Nyrhi
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teemu Luoto
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
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