Prior traumatic brain injury is a risk factor for in-hospital mortality in moderate to severe traumatic brain injury: a TRACK-TBI cohort study

Author:

Yue John KORCID,Etemad Leila L,Elguindy Mahmoud M,van Essen Thomas A,Belton Patrick J,Nelson Lindsay D,McCrea Michael A,Vreeburg Rick J G,Gotthardt Christine J,Tracey Joye X,Coskun Bukre C,Krishnan Nishanth,Halabi Cathra,Eagle Shawn R,Korley Frederick K,Robertson Claudia S,Duhaime Ann-Christine,Satris Gabriela G,Tarapore Phiroz E,Huang Michael C,Madhok Debbie Y,Giacino Joseph T,Mukherjee Pratik,Yuh Esther L,Valadka Alex B,Puccio Ava M,Okonkwo David O,Sun Xiaoying,Jain Sonia,Manley Geoffrey T,DiGiorgio Anthony M

Abstract

Objectives An estimated 14–23% of patients with traumatic brain injury (TBI) incur multiple lifetime TBIs. The relationship between prior TBI and outcomes in patients with moderate to severe TBI (msTBI) is not well delineated. We examined the associations between prior TBI, in-hospital mortality, and outcomes up to 12 months after injury in a prospective US msTBI cohort. Methods Data from hospitalized subjects with Glasgow Coma Scale score of 3–12 were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (enrollment period: 2014–2019). Prior TBI with amnesia or alteration of consciousness was assessed using the Ohio State University TBI Identification Method. Competing risk regressions adjusting for age, sex, psychiatric history, cranial injury and extracranial injury severity examined the associations between prior TBI and in-hospital mortality, with hospital discharged alive as the competing risk. Adjusted HRs (aHR (95% CI)) were reported. Multivariable logistic regressions assessed the associations between prior TBI, mortality, and unfavorable outcome (Glasgow Outcome Scale-Extended score 1–3 (vs. 4–8)) at 3, 6, and 12 months after injury. Results Of 405 acute msTBI subjects, 21.5% had prior TBI, which was associated with male sex (87.4% vs. 77.0%, p=0.037) and psychiatric history (34.5% vs. 20.7%, p=0.010). In-hospital mortality was 10.1% (prior TBI: 17.2%, no prior TBI: 8.2%, p=0.025). Competing risk regressions indicated that prior TBI was associated with likelihood of in-hospital mortality (aHR=2.06 (1.01–4.22)), but not with hospital discharged alive. Prior TBI was not associated with mortality or unfavorable outcomes at 3, 6, and 12 months. Conclusions After acute msTBI, prior TBI history is independently associated with in-hospital mortality but not with mortality or unfavorable outcomes within 12 months after injury. This selective association underscores the importance of collecting standardized prior TBI history data early after acute hospitalization to inform risk stratification. Prospective validation studies are needed. Level of evidence IV. Trial registration number NCT02119182 .

Funder

One Mind

Abbott Laboratories

Jackson Family Foundation

Neurosurgery Research and Education Foundation

National Institute of Neurological Disorders and Stroke

U.S. Department of Defense

NeuroTrauma Sciences

Publisher

BMJ

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1. Echoes of the past: does prior TBI shape future TBI outcomes?;Trauma Surgery & Acute Care Open;2024-08

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