Research Reports - Death after discharge: Predictors of mortality in older brain-injured patients

J Trauma Acute Care Surg. 2014 Sep 22

Peck KA(1), Calvo RY, Sise CB, Johnson J, Yen JW, Sise MJ, Dunne CE, Badiee J, Shackford SR, Lobatz MA

BACKGROUND: Older patients with traumatic brain injury (TBI) may be at high risk
of death after hospitalization. The purpose of this study was to characterize
long-term mortality of older TBI patients who survived to discharge. We
hypothesized that predictors of postdischarge mortality differed from those of
inpatient mortality.
METHODS: A retrospective cohort study was performed on TBI patients older than 55
years admitted to our Level I trauma center between July 1, 2006, and December
31, 2011. Postdischarge deaths were identified by matching patient data with
local vital records up to December 31, 2011, when data collection was terminated
(censoring). Patients were categorized by age, comorbidities, history of
preinjury anticoagulant/prescription antiplatelet agent therapy, injury severity
indices, initial TBI type, prehospital living status, discharge location, and
discharge condition. The effect of risk factors on postdischarge mortality was
evaluated by Cox proportional hazards modeling.
RESULTS: Of 353 patients, 322 (91.2%) survived to discharge. Postdischarge
mortality was 19.8% (n = 63) for the study period. Of the postdischarge deaths,
54.0% died within 6 months of discharge, and 68.3% died within 1 year. Median
days to death after discharge or censoring were 149 and 410, respectively.
Factors associated with death after discharge included age, preinjury
anticoagulant use, higher number of Charlson comorbidities, discharge to a
long-term care facility, and severe disability. Factors related to injury
severity (i.e., Injury Severity Score [ISS], initial Glasgow Coma Scale [GCS]
score) and preinjury prescription antiplatelet agent use, previously found to
predict inpatient death, did not predict postdischarge mortality.
CONCLUSION: Older TBI patients who survive to discharge have a significant risk
of death within 1 year. Predictors of postdischarge mortality and inpatient death
differ. Death after discharge is largely a function of overall health status.
Monitoring health status and continued aggressive management of comorbidities
after discharge may be essential in determining long-term outcomes.
LEVEL OF EVIDENCE: Epidemiologic/retrospective cohort analysis, level III.

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