Natus Resident/Fellow Award for Neurocritical Care (Neurotrauma): Prior Traumatic Brain Injury Is a Risk Factor for In-Hospital Mortality After Moderate to Severe Traumatic Brain Injury

Sunday, May 5, 2024

1:32 PM – 1:37 PM CT

Location: S401ab

Presenting Author(s)

John K. Yue, MD

Resident Physician (PGY-6)
Department of Neurological Surgery, University of California, San Francisco
Daly City, CA, US

Co-Author(s)

Anthony M. DiGiorgio, DO, MHA

Assistant Professor
Department of Neurological Surgery, University of California, San Francisco
San Francisco, California, United States
LE

Leila L. Etemad, BA

Research Associate
Department of Neurological Surgery, University of California, San Francisco, United States
SJ

Sonia Jain, PhD

Professor
Biostatistics Research Center, University of California, San Diego, United States
Geoffrey T. Manley, MD, PhD

Professor, Vice Chair
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
AM

Amy J. Markowitz, JD

Program Manager
Department of Neurological Surgery, University of California, San Francisco, United States
XS

Xiaoying Sun, MS

Statistician
Biostatistics Research Center, University of California, San Diego, United States

Disclosure(s):

John K. Yue, MD: No financial relationships to disclose

Anthony M. DiGiorgio, DO, MHA: AOSpine Foundation: Grant/Research Support (Ongoing); DePuy Synthes Spine: Grant/Research Support (Ongoing)

Geoffrey T. Manley, MD, PhD: No financial relationships to disclose

Introduction: An estimated 7-23% of traumatic brain injury (TBI) patients report history of prior TBI, which raises the risk for poorer outcomes. The associations between prior TBI, medical history and injury factors, in-hospital mortality, and 6- and 12-month outcomes were investigated in a prospective cohort of United States (US) patients presenting with moderate-to-severe TBI.

Methods: The Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study enrolled TBI patients who presented to hospital and received a clinically-indicated head computed tomography scan within 24 hours of TBI across 18 Level 1 trauma centers between 2014-2018. Data from hospitalized subjects with moderate-to-severe TBI (arrival Glasgow Coma Scale (GCS)=3-12) were extracted. History of prior TBI with loss-of-consciousness was identified using the Ohio State University TBI Identification Method (OSU-TBI-ID). Sociodemographic and clinical characteristics were compared between subjects with and without prior TBI. Multivariable logistic regressions adjusting for age, sex, psychiatric history, GCS, and injury severity score were used to evaluate prior TBI as a risk factor of in-hospital mortality, and 6- and 12-month unfavorable outcome (Glasgow Outcome Scale-Extended (GOSE)=1-3 vs. 4-8).

Results: Of 411 hospitalized moderate-to-severe TBI subjects, 21.4% reported history of prior TBI. Amongst baseline factors, prior TBI (vs. no prior TBI) was associated with male sex (87.5%/77.1%, p=0.037) and history of any psychiatric disorder (34.1%/21.1%, p=0.016), notably anxiety (18.2%/9.9%, p=0.04). Median hospital length of stay was 14 days (interquartile range: 6-24 days). Overall in-hospital mortality was 10.1%, which was higher for prior TBI (17.2%/8.2%, p=0.025). On multivariable regression, prior TBI was an independent predictor of in-hospital mortality (hazard ratio=1.98, 95% confidence interval [1.05-3.76], p=0.036). Prior TBI was not statistically associated with 6- or 12-month unfavorable outcome.

Conclusion : In a prospective cohort with moderate-to-severe TBI, history of prior TBI is independently associated with in-hospital mortality. This risk may be related to specific sociodemographic and clinical factors, which are increased in moderate-to-severe TBI patients with repetitive TBI. Longitudinal investigations into both the risks for and outcomes of repetitive TBI constitute relevant next steps.