212210 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

Tuesday, November 10, 2009: 4:30 PM

Alvaro I. Sanchez, MD , Center for Injury Research and Control, University of Pittsburgh, Pittsburgh, PA
Robert T. Krafty, PhD , Department of Statistics, University of Pittsburgh, Pittsburgh, PA
Harold B. Weiss, PhD , Center for Injury Research and Control, University of Pittsburgh, Pittsburgh, PA
JuanCarlos Puyana, MD , Department of Surgery, University of Pittsburgh, Pittsburgh, PA
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.

Learning Objectives:
Assess if the incidence of severe TBI in adults aged 18 years or older, the related in-hospital mortality, and the functional status at hospital discharge of severe TBI adult patients who were discharged alive, have changed significantly over years from 1998 to 2007.

Keywords: Traumatic Brain Injury, Disability

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This is a research done by myself as a substantive project to obtain a Master degree in clinical research at the University of Pittsburgh.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.