Brain Advance Access originally published online on August 8, 2007
Brain 2007 130(10):2520-2527; doi:10.1093/brain/awm185
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Death rate is increased for at least 7 years after head injury: a prospective study
1Psychological Medicine, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 OXH, UK and 2NHS Quality Improvement Scotland, Delta House 50 West Nile St, Glasgow G1 2 NP and Division of Clinical Neurosciences, University of Glasgow, UK
Correspondence to: Professor Tom McMillan, Psychological Medicine, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 OXH, UK E-mail: t.m.mcmillan{at}clinmed.gla.ac.uk
Although a high mortality rate among patients recently admitted to hospital with severe head injury is well recognized, less is known about their later mortality and very little about the ensuing lifestyle and less-severe injuries that lead to death. The aims of this study were to determine the rate of death in the first and six subsequent years after head injury, in a prospectively identified cohort admitted to hospital, and investigate the factors associated with death—comparing these with general death rates in Scottish populations. A structured sample of 767 patients aged 14 years and over was identified at the time of admission to hospital after a head injury and followed up 7 years later. A trace exercise was conducted to identify those deceased. The General Register of Scotland confirmed death and provided information about cause of death. Seven years after head injury, 206/767 (27%) people had died. Compared to the Glasgow population, risk of death was high after head injury in months 1–2 (23 times), 3–12 (3 times) and 13–84 (2 times), and overall was especially raised in younger people, even late (13–84 months) after injury (7 times). Mortality was only associated with greater severity of head injury during year 1. Pre-injury medical history was associated both with earlier and later deaths, but risk of death remained higher in those with no such history. Later deaths were often associated with lifestyle post-injury. The primary causes of death after head injury were the same as those in the general population. Compared to the general population, the death rate after admission to hospital with head injury remains high for at least 7 years, and is particularly high for those aged under 55 years. Interventions aimed at change in lifestyle may reduce this continuing excess mortality.
Key Words: head; brain; injury mortality; outcome
Abbreviations: GROS, General Register Office for Scotland
Received March 27, 2007. Revised July 13, 2007. Accepted July 16, 2007.
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