Long-Term Mortality of Patients With Head Injuries—A 10-Year Follow-up Study With Population Controls Study Performed at Tampere University Hospital

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BACKGROUND AND OBJECTIVES: Increased mortality in the acute phase after traumatic brain injury (TBI) is well established, and there is good evidence suggesting increased long-term mortality as well. Although the reasons for increased acute phase mortality are mostly intuitive, factors associated with long-term mortality are not well understood. The objective of this study was to compare survival and causes of deaths among patients with head injuries and matched population controls. METHODS: Ten-year survival and causes of deaths were compared between a cohort of consecutive patients with traumatic head injuries from one university hospital's emergency department (n = 1930) and matched population controls (n = 9605). Patient-control matching was conducted by age, sex, and the place of residence. RESULTS: After excluding those who died during the first year after injury, the hazard ratio for death was 1.84 when comparing patients with controls. Death rates were higher among patients up to 5 years after injury with a statistically significant difference. Analyses of specific causes of deaths revealed that unintentional and traumatic causes (9.6 vs 4.4%) and alcohol-related causes (8.4 vs 1.9%) differed significantly between groups with predominance among patients. When comparing patients with different severities of TBI with their matched controls, patients with no documented TBI had reduced survival, and TBI severity was associated with additional increase in mortality risk. Patient characteristics, and not injury-related factors, were associated with elevated risk of death in a multivariate model containing only patients. CONCLUSION: Long-term survival was reduced in patients with head injuries. Much of the reduced survival was associated with patient characteristics rather than injury severity-related factors. When comparing patients with different severities of TBI to their matched controls in isolation, patients with no documented TBI had reduced survival, and TBI severity was still associated with additional increase in mortality risk.

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