Mortality following Traumatic Brain Injury Inpatient Rehabilitation

The aim of this study was to examine the rate and causes of mortality following mild to severe traumatic brain injury (TBI) rehabilitation and to develop a multivariate prognostic model of mortality. We conducted a cohort study of 3341 individuals with mild to severe TBI followed-up from a post-acute inpatient rehabilitation center. Rate of death and survival between one and 26 years following injury were examined using standardized mortality ratios (SMRs) and prognostic models developed using Cox regression. A mortality rate of 9.3% was observed and an overall SMR of 1.04 (95% confidence interval [CI]=1.04-1.05). A statistically significant elevated SMR of 1.20 (95% CI=1.06-1.37) was observed for males, and both males and females had an elevated risk of death from external causes. Females also were found to have a significantly elevated SMR of 5.02 (95% CI=1.36-12.80) for intentional self-harm. Individuals ages 15-44 had a two-fold increase in mortality, compared with the general population. The multivariate Cox model indicated that increased risk of mortality was associated with older age, being male, being unemployed prior to injury, having a history of stroke, alcohol use, mental health issues, and back injury sustained in the accident. Premorbid lifestyle factors exerted a greater influence on mortality following TBI, compared with injury-related factors. This risk was especially prominent for younger individuals, who died primarily due to external causes. These findings highlight the need for interventions that address premorbid issues, such as substance abuse and mental health issues.