Causes of Death Following 1 year Postinjury Among Individuals with Traumatic Brain Injury (TBI).

Past Studies

Past Studies have had limited information about causes of death for individuals surviving initial hospitalization for TBI. Several studies have implicated seizures, external causes of injury and suicide as causes of death in this population. Other studies have found circulatory and respiratory diseases the more common causes of death. Some studies even suggested that as soon as two to ten years following injury, the TBI population begins to reflect the same patterns of death as seen in the general population.

A more recent study done on individuals who completed inpatient rehabilitation at one of the Model Systems of Care hospitals’ (rehabilitation facilities funded by the National Institute on Disability and Rehabilitation Research-NIDRR) found that individuals with TBI were twice as likely to die as individuals in the general population of similar age, gender and race. This resulted in life expectancy being reduced seven years for individuals with TBI and showed the strongest independent risk factors for death after one (1) year post-injury as older age, unemployment at injury, and having greater disability at time of discharge from inpatient rehabilitation.

This Study

This Study investigates the causes of death of those that died after one (1) year post-injury in 2,140 individuals who completed inpatient rehabilitation between 1988-2000. Data for the study is from the Model Systems National Database, Social Security Death Index, death certificates and US population age-race-gender-cause specific mortality rates for 1994. The hypothesis of the authors is that causes of death in individuals with TBI who have completed inpatient rehabilitation and survived at least one (1) year post-injury do not match causes of death and may have a higher death rate than the general population. The authors theorize that deaths from seizures, circulatory, respiratory and external causes (including suicide) are higher in individuals with TBI than in the general population.

Results of the study found that individuals with TBI were thirty-seven (37) times more likely to die from seizures, twelve (12) times more likely to die of septicemia (blood poisoning), four (4) times more likely to die of pneumonia and about three (3) times more likely to die of other respiratory conditions (excluding pneumonia), digestive disorders and external causes of injury/poisoning than were individuals in the general population having similar characteristics of age, gender and race.

Who May Be Affected By These Finding

Individuals with TBI, their family, caregivers, health professionals, community providers and researchers.

Caveat

The strength of this study is the use of a large multi-center sample with a high rate of follow-up from Model Systems’ database. Limitations include the short time period following injury (up to 13 years) for looking at long-term mortality rates; not considering other important factors which may contribute to mortality beyond age, gender and race; using death certificates which may be inaccurate or incomplete, and non-inclusion of patient data from two of the non-participating Model Systems’ hospitals whose patients may have had more serious injuries. Another important limitation is that results may not be representative of individuals who may have received a different level of inpatient care elsewhere.

Bottom Line

Causes of death in individuals with TBI receiving inpatient rehabilitation and surviving at least one (1) year post-injury may be greater than expected. Understanding why this happens and whether lifestyles and medical interventions can help prevent some of these deaths and prolong life expectancy are important. Education of family members about how to manage seizures, monitor and seek appropriate treatment and provide an environment which prevents death and disease is necessary.

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