Late mortality after severe traumatic brain injury in New South Wales: a multicentre study

Abstract

To determine the long-term mortality pattern of adults with severe traumatic brain injury (TBI), and to identify the risk factors associated with death in this group. Inception cohort study of 2545adults consecutively discharged from one of three metropolitan tertiary, post-acute inpatient rehabilitation services of the New South Wales Brain Injury Rehabilitation Program from 1January 1990to 1October 2007after inpatient rehabilitation for primary TBI. Survival status at 1October 2009. 258deaths were recorded in this sample, yielding a standardised mortality ratio of 3.19(95% CI, 2.80-3.60). Risk of death remained elevated above societal norms for at least 8years after discharge from rehabilitation. Mortality risk was increased by: functional dependence at discharge; age at injury; pre-injury drug and alcohol misuse; pre-injury epilepsy; and discharge to an aged care facility. The risk of death from external causes, and respiratory system and nervous system disorders was six to seven times higher, and the risk of death from disorders of the digestive system, and mental and behavioural disorders was five times higher in adults with severe TBI than in the general population. People who survive to discharge from inpatient rehabilitation following a severe TBI were found to have a sustained increase in risk of death for eight years post discharge. Various demographic and injury-related variables selectively increase mortality risk and may be modifiable in order to reduce the observed increase in mortality.