Impact of pre-existing bleeding disorders on outcomes in patients with traumatic brain injury

Traumatic brain injury (TBI) remains a major global public health problem. This study aimed to evaluate the association between pre-existing bleeding disorders and clinical outcomes among patients with TBI. We hypothesized that pre-existing bleeding disorders would be associated with worse outcomes following TBI.

We conducted a retrospective cohort study using the 2021-2023 National Inpatient Sample (NIS) to evaluate the association between pre-existing bleeding disorders and clinical outcomes among patients aged 15 years or older hospitalized with TBI.

Mortality was significantly higher in the bleeding disorder group (13.9% vs. 4.8%; p < 0.001), the median length of stay was longer (5 days vs. 3 days; p < 0.001), median hospitalization costs were substantially higher (US $20,582 vs. US $13,515; p < 0.001), and discharge home was less frequent (44.8% vs. 61.6%; p < 0.001). After adjustment for age, comorbidity burden, injury severity, and other clinically relevant covariates, pre-existing bleeding disorders remained independently associated with higher odds of in-hospital mortality (adjusted OR, 2.31; 95% CI, 1.99-2.69).

Pre-existing bleeding disorders were independently associated with higher odds of in-hospital mortality after TBI. Patients with these disorders also experienced worse clinical outcomes. Early recognition and appropriate hemostatic assessment may support individualized management in this vulnerable population.