Trends in survival and early functional outcomes at hospital discharge associated with severe adult traumatic brain injuries: An analysis of the Pennsylvania Trauma Outcome Study Database, 1998-2007

Introduction: Few registry-based, statewide, or national estimates have reported trends in severe traumatic brain injury (TBI)-related disabilities. We aimed to assess if the incidence of severe adult TBI, related in-hospital mortality, and functional status at hospital discharge have changed during the last decade.

Methods: TBI patients >17 years admitted to accredited trauma centers in Pennsylvania, during 1998-2007, were selected. Head-neck Abbreviated Injury Scale (AIS) was categorized as severe TBI if AIS>3. Discharge status (death or alive) was assessed using logistic regressions to evaluate any significant variation over time. Functional independence measures (FIM) at hospital discharge for five domains: feeding, locomotion, expression, transfer mobility, and social interaction, were assessed using multinomial regressions to evaluate any significant variation over time. FIM in each domain were scored from 1 (Complete Dependence) to 4 (Complete Independence).

Results: At hospital discharge, survival increased from 72.5% to 82.7% (coefficient 0.045, 95%CI 0.029-0.061). The proportion of survivors completely independent increased from 43.2% to 50% for Social interaction (β=0.11, 95%CI=0.096-0.135) and from 26.9% to 28.2% for Locomotion (β=0.065, 95%CI=0.047-0.083). All models were adjusted for age, sex, comorbidities, injury type, injury intent, injury severity scores, other injuries, drug abuse, level of trauma center, and hospital stay.

Conclusions: Many people recovered from their TBI. However, at least half were discharged with some disability. TBI prevention to reduce the incidence of severe TBI and increased access to services for those who do not fully recover must be a high priority.