Abstract
Traumatic brain injury (TBI) is an important health issue with high mortality. Various complications of physiological and cognitive impairment may result in disability or death after TBI. Grouping of these complications could be treated as integrated post-TBI syndromes. To improve risk estimation, grouping TBI complications should be investigated, to better predict TBI mortality. This study aimed to estimate mortality risk based on grouping of complications among TBI patients. Taiwan's National Health Insurance Research Database was used in this study. TBI was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes: 801–804 and 850–854. The association rule data mining method was used to analyze coexisting complications after TBI. The mortality risk of post-TBI complication sets with the potential risk factors was estimated using Cox regression. A total 139,254 TBI patients were enrolled in this study. Intracerebral hemorrhage was the most common complication among TBI patients. After frequent item set mining, the most common post-TBI grouping of complications comprised pneumonia caused by acute respiratory failure (ARF) and urinary tract infection, with mortality risk 1.55 (95% C.I.: 1.51–1.60), compared with those without the selected combinations. TBI patients with the combined combinations have high mortality risk, especially those aged <20 years with septicemia, pneumonia, and ARF (HR: 4.95, 95% C.I.: 3.55–6.88). We used post-TBI complication sets to estimate mortality risk among TBI patients. According to the combinations determined by mining, especially the combination of septicemia with pneumonia and ARF, TBI patients have a 1.73-fold increased mortality risk, after controlling for potential demographic and clinical confounders. TBI patients aged<20 years with each combination of complications also have increased mortality risk. These results could provide physicians and caregivers with important information to increase their awareness about sequences of clinical syndromes among TBI patients, to prevent possible deaths among these patients.
Highlights
Traumatic brain injury (TBI), a major cause of morbidity and mortality in many countries [1,2], is an important global public health problem
TBI patients aged over 65 years had the highest risk of death (HR = 27.64, 95% confidence interval (CI) = 24.64–29.71)
To the best of our knowledge, this is the first study to report the risk of mortality based on grouping of post-TBI complications among TBI patients using population-based administrative data
Summary
Traumatic brain injury (TBI), a major cause of morbidity and mortality in many countries [1,2], is an important global public health problem. It has been shown that sleep problems are a common symptom during and after TBI [9,17,18] and that patients with sleep disorders have an increased risk of stroke. It remains unknown how the combined effect of stroke and sleep disorders affects the risk of death among TBI patients. Diseases and symptoms should be grouped together as a more meaningful risk factor to examine the combined effect of disease and disease, symptoms and symptoms, or disease and symptoms on mortality risk in patients with TBI. The relationships between diseases and symptoms in large databases could be grouped using an association rule approach, to discover potential patterns [19]
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