Patient outcomes post self-inflicted traumatic brain injury during the acute phase

To determine the prevalence of Self-inflicted Traumatic Brain Injury (Si-TBI) patients within a large clinical TBI sample, and to compare Si-TBI patients with matched controls on pre- and post-injury characteristics and functional outcomes.

In this retrospective matched case-control study, all TBI patients admitted between 2015 and 2021 were screened to identify cases of Si-TBI. Each Si-TBI patient was matched to two non-Si-TBI controls based on age, sex, education level, TBI severity, and mechanism of injury. Variables of interest included premorbid psychosocial and medical characteristics, and acute outcome measures such as Glasgow Outcome Scale - Extended (GOSE), length of stay (LOS), and discharge destination.

In total, 1.6% of all TBIs were Si-TBIs. Si-TBI patients were associated with a greater psychiatric history (p < 0.001), poorer social support (p < 0.001), higher Injury Severity Scores (ISS) (p = 0.002), longer LOS (p = 0.033), and lower GOSE (p = 0.003). During hospitalization, more Si-TBI patients exhibited verbal aggression (p = 0.002), required sitters (p < 0.001), and received psychiatric diagnoses (p < 0.001) and medications (p = 0.002). Exploratory bivariate correlations within the Si-TBI group showed expected associations between injury severity indicators and functional outcomes, with more severe injuries linked to poorer recovery markers.

Si-TBI patients possess a more complex pre-morbid status, more severe injuries, more resource-intensive hospitalization, and poorer outcomes.