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10 OTHER HEALTH OUTCOMES
Pages 333-366

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From page 333...
... MORTALITY AND TRAUMATIC BRAIN INJURY PRIMARY STUDIES Mortality and Traumatic Brain Injury in Military Populations That head injuries reduce life expectancy has been posited since World War I Medical records of Bavarian World War I veterans who were patients at a head-injury center were analyzed in 1964–1966 (Walker et al., 1971)
From page 334...
... Length of coma was the best predictor of long-term outcome, and posttraumatic epilepsy was not a significant factor in mortality in the first 15 years, although each seizure event carried its own inherent risk. Mortality and Traumatic Brain Injury in Civilian Populations Mortality in TBI patients can be studied from the time of injury, from the time of discharge from inpatient acute-care hospitals, or from the time of admission into or discharge from inpatient rehabilitation.
From page 335...
... Patients who were treated in hospitals with trauma centers were less likely to die within 15 months after hospital discharge than patients treated in hospitals without trauma centers. Mortality in Patients Admitted into or Discharged from Rehabilitation Centers In a retrospective cohort study, Baguley et al.
From page 336...
... (2004) studied 2,178 patients with moderate to severe TBI identified in the Traumatic Brain Injury Model Systems (TBIMS)
From page 337...
... The study population consisted of 1,839 severely headinjured patients, whose data were extracted retrospectively from the Traumatic Brain Injury Data Bank (635 patients) , the Medical College of Virginia (382)
From page 338...
... studied outcomes in a cohort of 810 patients with severe closed head injuries who were consecutively admitted to a hospital in Spain in 1987–1996. Severe head injury was defined as a GCS at admission of no more than 8 or deterioration to this level 48 hours after injury.
From page 339...
... The committee has reviewed 10 primary studies and 12 secondary studies of TBI and mortality and has found consistent results. The committee concludes, on the basis of its evaluation, that there is sufficient evidence of a causal relationship between penetrating TBI and premature mortality in survivors of the acute injury.
From page 340...
... 340 TABLE 10.1 TBI and Mortality Health Outcomes or Outcome Comments or Reference Study Design Population Type of TBI Measures Results Adjustments Limitations Baguley et Cohort Patients with TBI Severe; 97% Mortality by 476 patients, mean None Missing FAM, al., 2000 composed of admitted to Brain closed, August 1997 duration of followup preinjury clinical case Injury 3% penetrating (mean, 5 years 64 mo; 97% closed information on series Rehabilitation after trauma; head injury, 3% substance abuse, Service, Westmead range, 8 mo–11 penetrating head psychiatric Hospital, New years after injury; 62% MVC, history from South Wales, trauma) ; 21% falls or hit by patients admitted Australia, 1986– ascertained by object, 12% assault, before 1990 on 1996; cases had New South Wales 4% sports-related 52% of the survived through vital-statistics deceased, 22% admission into search 27 of 476 (5.7%; 95% of the living; no rehabilitation CI, 0.037–0.083)
From page 341...
... Brown et Population- Any Olmsted Documented Vital status Age 35.3 years for Age, sex for Unique database al., 2004 based County, MN, concussion with through 2002 moderate–severe, 26.8 mortality on medical care retrospective resident with LOC; PTA; from medical years for mild; mean analysis; of county's cohort from medically attended neurologic records, state followup, 7.4 years age, sex, year entire Rochester TBI, 1985–1999 (N signs of brain death tapes of TBI with population; Epidemiology = 45,831) ; random injury and/or Mortality in moderate– Cox cohort not Project 15.7% sample of intracerebral, severe: proportional- generalizable TBI patients (N = subdural, or 68 deaths in 164 cases; hazards beyond Olmsted 7,175)
From page 342...
... with proportional could not be War II head injury from after trauma function of penetrating head injury regression determined on veterans Teuber series (n = various factors dead vs 18 of 106 adjusted for only one subject assembled at 190) ; excludes few (17.0%)
From page 343...
... ; proportional not participate, comparison group: life expectancy, hazards for so sample less US age- and sex- Severity: 37% average reduction, 7 those representative specific mortality severe (24-h years, depending on surviving >1 in 1994 max GCS 8) age at injury, sex, race, year with range 5–9 years ALOS: 21 days acute care, 30 Risk factors: higher days acute age, unemployment at rehabilitation time of injury, higher DRS score at discharge Lewin et Retrospective 7,000 consecutive Severe in large Vital status; for Overall mortality, 178 Age, Only 2% loss to al., 1979 cohort head injured part closed, but 178 (consecutive of 469 (38%)
From page 344...
... dead Hospitalization: continuing need discussed but not quantified Ratcliff et Retrospective 640 patients 14 Head injury Mortality through Overall mortality: 128 Age at injury, Subjects outside al., 2005 cohort years old with identified by 1997 (19.7%) deaths; SMR, sex, range of interest moderate to severe ICD-8 and -9 2.78; p < 0.0001 by education, for age at time of TBIs discharged 8– codes 800–801- Poisson regression marital status, injury: 24 years after 9, 803–804.9, race, cause of <18 years, 19%; trauma from 850–854.9, Any preinjury social or injury, 60 years, 13%
From page 345...
... Health Outcomes or Outcome Comments or Reference Study Design Population Type of TBI Measures Results Adjustments Limitations Pittsburgh, PA, excluding behavioral problem: severity of rehabilitation comorbid spine SMR, 5.82, p < 0.0001 injury Followup, 8–24 center, 1974–1984, injury year after 1988, 1989; Alcohol abuse: SMR, trauma; excluded comparison group Cause of injury: 6.10; p < 0.0001 1985–1987 to from Pennsylvania MVC, 66%; keep sample size vital-statistics violence, 2%; Substance abuse: smaller, tables falls, 16%; SMR, 8.00; p < 0.0001 manageable; other, 15% 6.5% could not Other personal or be traced Moderate to social problems: SMR, (assumed alive) ; severe cases 7.03; p < 0.0001 univariate (range, 4–54)
From page 346...
... 346 Health Outcomes or Outcome Comments or Reference Study Design Population Type of TBI Measures Results Adjustments Limitations Rish et al., Prospective 1,127 male Penetrating Mortality 15 years Overall mortality: 90 Age and sex Exclusively 1983 cohort Vietnam veterans cerebrocranial after trauma of 1127 (8%) , 46 in penetrating (registry alive 1 week after wounds first year after trauma, injuries, whose established trauma; 32 in first 3 mo, 16 in consequences 1976–1980 by comparison group: first month; compared may differ from MFUA, WF age- and sex- with North American those of Caveness)
From page 347...
... , SMR, related deaths 11.7 (95% CI, 8.2– related to 15.9) original TBI Risk of death Did not find associated with age, excess deaths number of associated with comorbidities, AIS seizures, 4, Medicare, care in respiratory nontrauma center infections, choking and suffocation, suicide Shavelle et Retrospective 2,629 people with TBI by ICD-9 Mortality as Mortality ratio: Stratified by Patients with al., 2000 cohort TBI >15 years old, codes 800–804, recorded in state overall, 277%; ambulation severe in 1988–1997, 850–854 vital statistics nonambulatory status disabilities only, receiving services patients, 660%; not analogous to from California partially ambulatory, incident cohort Department of 196%; ambulatory, Developmental 180% 347
From page 348...
... epilepsy at "some calculated for >35 derived by primitive; biases from among 5,500 time after injury" years; 73% of cases, assuming that likely in cases in head- (first event for 80% of controls alive those with selection of injury center in most within year at age 65 years; across unknown study population 1916–1927 with of injury, but all age bands, life vital status (for example, "sufficient persisted for expectancy was were all alive representativenes information for most) ; broad increasingly lower for or were s of cases at analysis" of nature classifications of control veterans, head random center of all head of injury; 1,000 cause of death injured without sample of injured and of unwounded epilepsy, head injured population those with Bavarian WWI with epilepsy in sufficient veterans on comparison with information of pension lists for general population; all cases; receiving medal; aside from sequelae of controls all all born 1880– injuries, no cause of received 1900; final, 555 death stood out for medals)
From page 349...
... , not related to three measures of severity; cardiovascular–renal, no difference NOTE: AGCT = Army General Classification Test, AIS = Abbreviated Injury Scale, ALOS = average length of stay, CFR = case-fatality rate, CI = confidence interval, CNS = central nervous system, CSF = cerebrospinal fluid, CT = computed tomography, FAM = Functional Assessment Measure, GCS = Glasgow Coma Scale, GOS = Glasgow Outcome Score, ICD = International Classification of Diseases, LOC = loss of consciousness, MFUA = Medical Follow-Up Agency, MVC = motor-vehicle crash, NYU = New York University, PT = posttrauma, PTA = posttraumatic amnesia, RH = relative hazards, RR = relative risk, SMR = standardized mortality ratio, SSA = Social Security Administration, TBI = traumatic brain injury. WWI = World War I
From page 350...
... . Gliomas, which are primary brain tumors, form in the glial cells of the brain or spinal cord and can spread throughout the nervous system.
From page 351...
... There were 400 brain tumors during the period, but 119 that occurred in the first year after injury were excluded, and this left 281 cases of brain cancer (55 benign meningiomas; 161 primary brain tumors, including astrocytomas, glioblastomas, and gliomas; and 65 other brain tumors)
From page 352...
... A hospital-based case–control study in Rio de Janeiro, Brazil (Monteiro et al., 2006) , found increased odds of brain tumors in adults who had experienced a TBI.
From page 353...
... Women who received a diagnosis in 1972–1975 completed questionnaires regarding risk factors; questionnaires were returned by 189 subjects and 185 controls. A history of medically treated TBI was a risk factor for meningioma (OR, 2.0; 95% CI, 1.2–3.5)
From page 354...
... , but the increase was not seen in connection with other latent periods or in women. In a study of primary brain tumors in residents of the Rein-Neckar-Odenwald area of Germany, Schlehofer et al.
From page 355...
... (1994) conducted a case–control study to assess risk factors related to brain tumors in 195 patients who presented with confirmed cerebral glioma in four neurosurgical departments in Italy.
From page 356...
... not trauma; no significant overall or for two Expected numbers known pre- tumor types of tumors not existing tumor; adjusted for age or comparator data sex to match study from previous population incidence study of brain tumors in Olmsted County Burch et Case– All brain tumors Accidents, injuries Brain tumors 215 matched pairs analyzed; Matching on Excluded al., 1987 control in Toronto and that involved head more cases than controls basis of sex, area spongioblastomas, southern Ontario (not further reported injuries involving of residence, ependymomas, diagnosed in specified) head (RR, 2.51; p 0.0001)
From page 357...
... for 15 years old at participated; impairment of time of TBI 125 friend memory, hearing, controls matched or vision; mild: by 5-year age well-described group concussion or brief LOC without other complications Hu et al., Case– Cases from six History of head Histologically 34 of 218 cases vs 10 of 416 Matching on age Alcohol and skull 1998 control major hospitals trauma by self- confirmed controls reported head (±5 years) , sex, x-rays also found in Heilongjiang report primary trauma; adjusted OR, 4.85 area of residence as risk factors Province, China, gliomas (95% CI, 2.52–9.44)
From page 358...
... ; type compared comparator, with Danish Danish population population without TBI without history of TBI Monteiro et Hospital- 231 patients 30– Head injury >1year New diagnosis Association with prior head Age, sex, Only 80% of cases al., 2006 based case– 65 years old before diagnosis of of primary injury: adjusted OR, 1.49 education, confirmed control newly diagnosed brain neoplasm brain (95% CI, 1.03–2.15) epilepsy, alcohol histopathologically, with primary (cases)
From page 359...
... ; problem in these incidence rates severe with Death benign meningiomas, SIR, negative findings; for Swedish neurosurgery Register, 1.0 (95% CI, 0.5–1.8) ; design adopted population Emigration primary brain tumors, SIR, because of question Register 1.4 (95% CI, 1.0–1.8)
From page 360...
... ascertainment of meningiomas in registry of malignant diagnoses unknown Phillips et Population- 200 cases newly History of head Newly 99 cases, 142 controls with Age at diagnosis, Participation 84% al., 2002 based case– diagnosed in trauma by self- diagnosed any head trauma: OR, 1.83 sex, skull in cases, 55% control January 1995– report; considered meningiomas (95% CI, 1.28–2.62) ; mild, radiography, CT random-digit June 1998, 18 "serious" if LOC, (intracranial)
From page 361...
... ; by interviewers not identified by history selecting blinded to case– through cancer controls from control status registry living in neighborhood, Los Angeles also matched by Differential recall County; one socioeconomic bias matched control status; per case from multivariate neighborhood logistic regression Preston- Case– Cases, men 65 Head injury >2 Meningiomas, 105 matched pairs analyzed Matched by sex, One-sided tests of Martin et control years old with years before histologically with exact binomial test: race or ethnicity, significance; al., 1983 intracranial diagnosis by confirmed serious head injury not year of birth (±5 differential recall meningiomas history; severe related to boxing, OR, 1.9 (p years) ; by bias identified head injury defined = 0.01)
From page 362...
... ; SES; Los Angeles meningioma, OR 2.1 (95% multivariate County; one CI, 1.1–5.4) logistic matched regression neighborhood For meningiomas only, control per case number of serious head injuries, p for trend = 0.01 Preston- Case– Cases from eight Medically treated Gliomas and 297 gliomas, 59 Individual and Subject to recall Martin et control centers in six head injuries; meningiomas meningiomas frequency bias; different al., 1998 countries subgroup of serious matching by age methods used for (Adelaide, TBI: medically Glioma: any TBI, males, and sex; some matching at Melbourne, treated injuries that OR, 1.18 (95% CI, 0.94– centers matched different centers Australia; resulted in LOC, 1.48)
From page 363...
... NOTE: CI = confidence interval, CNS = central nervous system, CT = computed tomography, ED = emergency department, ICD = International Classification of Diseases, LOC = loss of consciousness, OR = odds ratio, PT = posttrauma, PTA = posttraumatic amnesia, RDD = random-digit dialing, RR = relative risk, SES = socioeconomic status, SIR = standardized incidence ratio, TBI = traumatic brain injury.
From page 364...
... 2004. Mortality following rehabilitation in the traumatic brain injury model systems of care.
From page 365...
... 2001. Primary brain tumors following traumatic brain injury -- a population-based cohort study in Sweden.
From page 366...
... 2005. Long-term survival following traumatic brain injury.


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