Risk of Mortality Among Adult Females Diagnosed with Traumatic Brain Injury in an Academic Medical System.

IF 1.8 Q3 CLINICAL NEUROLOGY
Neurotrauma reports Pub Date : 2025-08-01 eCollection Date: 2025-01-01 DOI:10.1177/08977151251361700
Bernadette A D'Alonzo, Abigail C Bretzin, Rebecca B Morse, Silvia P Canelón, Douglas J Wiebe, Andrea L C Schneider, Mary Regina Boland
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Abstract

The objective of this retrospective cohort study was to evaluate mortality risk over five years among 6,432 female patients with a health care encounter diagnosis of TBI from hospitals and outpatient clinics within a university health system. We used TBI severity, defined by the Centers for Disease Control and Department of Defense/Veterans Affairs: mild, moderate/severe/penetrating, indeterminate severity. To determine patient death, we used death in a Penn Medicine facility and linkage to the Social Security Death Index. We used Cox proportional hazards models adjusted for age at the time of TBI diagnosis, race, and encounter type to estimate associations of TBI severity with mortality risk. We evaluated interactions with encounter type and age, and stratified results by inpatient/outpatient and age group (≥65 years). Median age was 47 years (25th-75th percentiles: 29-63). Patients were most commonly self-reported White race (n = 4,126, 64.0%), and diagnosed at an outpatient encounter (n = 5,099, 79.3%; among them, 1-2% urgent/emergent). Median follow-up time was 4.22 years (IQR, 2.3-4.9 years). Overall, 2.9% (n = 185) of patients died within five years of injury. Compared with mild TBI, mortality risk over five years was 2.06 times higher (95% CI = 1.27-3.33) for moderate/severe/penetrating TBI, and 1.54 times higher (95% CI = 0.98-2.42) for indeterminate TBI. Associations were attenuated among females with inpatient encounter type and those aged 65 years or older. Our results demonstrate that TBI severity affects survival among females, and this differs by encounter type and age. Findings motivate future, more focused research into the dynamics of TBI among females.

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学术医疗系统中诊断为外伤性脑损伤的成年女性的死亡率风险。
本回顾性队列研究的目的是评估一所大学卫生系统内医院和门诊诊断为TBI的6432名女性患者5年以上的死亡风险。我们使用疾病控制中心和国防部/退伍军人事务部定义的TBI严重程度:轻度、中度/严重/穿透性、不确定严重程度。为了确定病人的死亡情况,我们使用了宾夕法尼亚大学医学中心的死亡情况,并与社会安全死亡指数相关联。我们使用Cox比例风险模型对TBI诊断时的年龄、种族和遭遇类型进行调整,以估计TBI严重程度与死亡风险的关系。我们评估了与遭遇类型和年龄的相互作用,并根据住院/门诊患者和年龄组(≥65岁)对结果进行分层。中位年龄为47岁(25 -75百分位数:29-63)。患者最常自我报告为白人(n = 4,126, 64.0%),并在门诊就诊(n = 5,099, 79.3%;其中1-2%为紧急/紧急)。中位随访时间为4.22年(IQR, 2.3-4.9年)。总体而言,2.9% (n = 185)的患者在损伤后5年内死亡。与轻度TBI相比,中度/重度/穿透性TBI的5年死亡风险高2.06倍(95% CI = 1.27-3.33),不确定TBI的5年死亡风险高1.54倍(95% CI = 0.98-2.42)。在住院偶遇型和65岁以上的女性中,相关性减弱。我们的研究结果表明,创伤性脑损伤的严重程度会影响女性的生存,这因遭遇类型和年龄而异。这些发现激发了未来对女性创伤性脑损伤动态的更集中的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.40
自引率
0.00%
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审稿时长
8 weeks
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