Long-term survival and five year hospital resource usage following traumatic brain injury in Scotland from 1997 to 2015: A population-based retrospective cohort study

James J M Loan; Neil W Scott; Jan O Jansen

doi:10.1016/j.injury.2018.09.029

Long-term survival and five year hospital resource usage following traumatic brain injury in Scotland from 1997 to 2015: A population-based retrospective cohort study

James J M Loan, Neil W Scott, Jan O Jansen

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

BACKGROUND: It is unclear if traumatic brain injury (TBI) results in excess mortality compared with head injury without injury to neural structures (HI). Because TBI populations exhibit significant demographic differences from uninjured populations, to determine the effect of TBI on survival, it is essential that a similarly injured control population be used. We aimed to determine if survival and hospital resource usage differ following TBI compared with HI.

METHODS: This retrospective population-based cohort study included all 25 319 patients admitted to a Scottish NHS hospital from 1997 to 2015 with TBI. Participants were identified using previously validated ICD-10 based definitions. For comparison, a control group of all 194 049 HI cases was also identified. Our main outcome measures were hazards of all-cause mortality for patients with TBI, compared with those with HI, over the 18-year follow-up period; and odds of mortality at one month post-injury. Number of days spent as inpatients and number of outpatient attendances per surviving month post-injury were used as measures of resource utilisation.

RESULTS: The adjusted odds ratio for mortality in the first month post-injury for TBI, compared with HI, was 7.12 (95% confidence interval [CI] 6.73-7.52; p < 0.001). For the remaining 18-year study period, the hazards of morality after TBI were 0.93 (CI 0.90-0.96; p < 0.001). During the five-year post-injury period, brain injury was associated with 2.15 (CI 2.10-2.20; p < 0.001) more days spent as inpatient and 1.09 times more outpatient attendances (CI 1.07-1.11; p < 0.001) compared with HI.

CONCLUSIONS: Although initial mortality following TBI is high, survivors of the first month post-injury can achieve comparable long-term survival to HI. However, this is associated with, and may require, increased utilisation of hospital services in the TBI group.

Original language	English
Pages (from-to)	82-89
Number of pages	8
Journal	Injury
Volume	50
Issue number	1
Early online date	14 Sept 2018
DOIs	https://doi.org/10.1016/j.injury.2018.09.029
Publication status	Published - 31 Jan 2019

Bibliographical note

The study authors thank the Aberdeen Royal Infirmary Intensive Care Unit Endowment Fund for funding this study. The funders were not involved in the study design, conduct or reporting. We thank the Farr Institute for data extraction from the Scottish Morbidity Records.

Keywords

traumatic brain injury
survival analysis
resource usage
Scotland
head injury
cohort study
MORTALITY
Traumatic brain injury
Resource usage
MILD HEAD-INJURY
RISK
DEATH
CARE
DISCHARGE
Survival analysis
Head injury
Cohort study
DISEASE
REHABILITATION
COMA

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@article{58cee09b3b874d29be9630b1d456dc33,

title = "Long-term survival and five year hospital resource usage following traumatic brain injury in Scotland from 1997 to 2015: A population-based retrospective cohort study",

abstract = "BACKGROUND: It is unclear if traumatic brain injury (TBI) results in excess mortality compared with head injury without injury to neural structures (HI). Because TBI populations exhibit significant demographic differences from uninjured populations, to determine the effect of TBI on survival, it is essential that a similarly injured control population be used. We aimed to determine if survival and hospital resource usage differ following TBI compared with HI.METHODS: This retrospective population-based cohort study included all 25 319 patients admitted to a Scottish NHS hospital from 1997 to 2015 with TBI. Participants were identified using previously validated ICD-10 based definitions. For comparison, a control group of all 194 049 HI cases was also identified. Our main outcome measures were hazards of all-cause mortality for patients with TBI, compared with those with HI, over the 18-year follow-up period; and odds of mortality at one month post-injury. Number of days spent as inpatients and number of outpatient attendances per surviving month post-injury were used as measures of resource utilisation.RESULTS: The adjusted odds ratio for mortality in the first month post-injury for TBI, compared with HI, was 7.12 (95% confidence interval [CI] 6.73-7.52; p < 0.001). For the remaining 18-year study period, the hazards of morality after TBI were 0.93 (CI 0.90-0.96; p < 0.001). During the five-year post-injury period, brain injury was associated with 2.15 (CI 2.10-2.20; p < 0.001) more days spent as inpatient and 1.09 times more outpatient attendances (CI 1.07-1.11; p < 0.001) compared with HI.CONCLUSIONS: Although initial mortality following TBI is high, survivors of the first month post-injury can achieve comparable long-term survival to HI. However, this is associated with, and may require, increased utilisation of hospital services in the TBI group.",

keywords = "traumatic brain injury, survival analysis, resource usage, Scotland, head injury, cohort study, MORTALITY, Traumatic brain injury, Resource usage, MILD HEAD-INJURY, RISK, DEATH, CARE, DISCHARGE, Survival analysis, Head injury, Cohort study, DISEASE, REHABILITATION, COMA",

author = "Loan, {James J M} and Scott, {Neil W} and Jansen, {Jan O}",

note = "The study authors thank the Aberdeen Royal Infirmary Intensive Care Unit Endowment Fund for funding this study. The funders were not involved in the study design, conduct or reporting. We thank the Farr Institute for data extraction from the Scottish Morbidity Records.",

year = "2019",

month = jan,

day = "31",

doi = "10.1016/j.injury.2018.09.029",

language = "English",

volume = "50",

pages = "82--89",

journal = "Injury",

issn = "0020-1383",

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number = "1",

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T1 - Long-term survival and five year hospital resource usage following traumatic brain injury in Scotland from 1997 to 2015

T2 - A population-based retrospective cohort study

AU - Loan, James J M

AU - Scott, Neil W

AU - Jansen, Jan O

N1 - The study authors thank the Aberdeen Royal Infirmary Intensive Care Unit Endowment Fund for funding this study. The funders were not involved in the study design, conduct or reporting. We thank the Farr Institute for data extraction from the Scottish Morbidity Records.

PY - 2019/1/31

Y1 - 2019/1/31

N2 - BACKGROUND: It is unclear if traumatic brain injury (TBI) results in excess mortality compared with head injury without injury to neural structures (HI). Because TBI populations exhibit significant demographic differences from uninjured populations, to determine the effect of TBI on survival, it is essential that a similarly injured control population be used. We aimed to determine if survival and hospital resource usage differ following TBI compared with HI.METHODS: This retrospective population-based cohort study included all 25 319 patients admitted to a Scottish NHS hospital from 1997 to 2015 with TBI. Participants were identified using previously validated ICD-10 based definitions. For comparison, a control group of all 194 049 HI cases was also identified. Our main outcome measures were hazards of all-cause mortality for patients with TBI, compared with those with HI, over the 18-year follow-up period; and odds of mortality at one month post-injury. Number of days spent as inpatients and number of outpatient attendances per surviving month post-injury were used as measures of resource utilisation.RESULTS: The adjusted odds ratio for mortality in the first month post-injury for TBI, compared with HI, was 7.12 (95% confidence interval [CI] 6.73-7.52; p < 0.001). For the remaining 18-year study period, the hazards of morality after TBI were 0.93 (CI 0.90-0.96; p < 0.001). During the five-year post-injury period, brain injury was associated with 2.15 (CI 2.10-2.20; p < 0.001) more days spent as inpatient and 1.09 times more outpatient attendances (CI 1.07-1.11; p < 0.001) compared with HI.CONCLUSIONS: Although initial mortality following TBI is high, survivors of the first month post-injury can achieve comparable long-term survival to HI. However, this is associated with, and may require, increased utilisation of hospital services in the TBI group.

AB - BACKGROUND: It is unclear if traumatic brain injury (TBI) results in excess mortality compared with head injury without injury to neural structures (HI). Because TBI populations exhibit significant demographic differences from uninjured populations, to determine the effect of TBI on survival, it is essential that a similarly injured control population be used. We aimed to determine if survival and hospital resource usage differ following TBI compared with HI.METHODS: This retrospective population-based cohort study included all 25 319 patients admitted to a Scottish NHS hospital from 1997 to 2015 with TBI. Participants were identified using previously validated ICD-10 based definitions. For comparison, a control group of all 194 049 HI cases was also identified. Our main outcome measures were hazards of all-cause mortality for patients with TBI, compared with those with HI, over the 18-year follow-up period; and odds of mortality at one month post-injury. Number of days spent as inpatients and number of outpatient attendances per surviving month post-injury were used as measures of resource utilisation.RESULTS: The adjusted odds ratio for mortality in the first month post-injury for TBI, compared with HI, was 7.12 (95% confidence interval [CI] 6.73-7.52; p < 0.001). For the remaining 18-year study period, the hazards of morality after TBI were 0.93 (CI 0.90-0.96; p < 0.001). During the five-year post-injury period, brain injury was associated with 2.15 (CI 2.10-2.20; p < 0.001) more days spent as inpatient and 1.09 times more outpatient attendances (CI 1.07-1.11; p < 0.001) compared with HI.CONCLUSIONS: Although initial mortality following TBI is high, survivors of the first month post-injury can achieve comparable long-term survival to HI. However, this is associated with, and may require, increased utilisation of hospital services in the TBI group.

KW - traumatic brain injury

KW - survival analysis

KW - resource usage

KW - Scotland

KW - head injury

KW - cohort study

KW - MORTALITY

KW - Traumatic brain injury

KW - Resource usage

KW - MILD HEAD-INJURY

KW - RISK

KW - DEATH

KW - CARE

KW - DISCHARGE

KW - Survival analysis

KW - Head injury

KW - Cohort study

KW - DISEASE

KW - REHABILITATION

KW - COMA

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UR - http://www.mendeley.com/research/longterm-survival-five-year-hospital-resource-usage-following-traumatic-brain-injury-scotland-1997-2

U2 - 10.1016/j.injury.2018.09.029

DO - 10.1016/j.injury.2018.09.029

M3 - Article

C2 - 30266290

SN - 0020-1383

VL - 50

SP - 82

EP - 89

JO - Injury

JF - Injury

IS - 1

ER -

Long-term survival and five year hospital resource usage following traumatic brain injury in Scotland from 1997 to 2015: A population-based retrospective cohort study

Abstract

Bibliographical note

Keywords

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