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Trends in Survival and Early Functional Outcomes From Hospitalized Severe Adult Traumatic Brain Injuries, Pennsylvania, 1998 to 2007

Sánchez, Álvaro I. MD, MS; Krafty, Robert T. PhD; Weiss, Harold B. PhD, MPH; Rubiano, Andrés M. MD; Peitzman, Andrew B. MD; Puyana, Juan Carlos MD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: March/April 2012 - Volume 27 - Issue 2 - p 159–169
doi: 10.1097/HTR.0b013e3182074c41
Focus on Clinical Research and Practice, Part 1

Objective: To determine trends for in-hospital survival and functional outcomes at acute care hospital discharge for patients with severe adult traumatic brain injury (SATBI) in Pennsylvania, during 1998 to 2007.

Methods: Secondary analysis of the Pennsylvania trauma outcome study database.

Main Outcome Measures: Survival and functional status scores of 5 domains (feeding, locomotion, expression, transfer mobility, and social interaction) fitted into logistic regression models adjusted for age, sex, race, comorbidities, injury mechanism, extracranial injuries, severity scores, hospital stay, trauma center, and hospital level. Sensitivity analyses for functional outcomes were performed.

Results: There were 26 234 SATBI patients. Annual numbers of SATBI increased from 1757 to 3808 during 1998 to 2007. Falls accounted for 47.7% of all SATBI. Survival increased significantly from 72.5% to 82.7% (odds ratio [OR] = 1.10, 95% CI: 1.08–1.11, P < .001). In sensitivity analyses, trends of complete independence in functional outcomes increased significantly for expression (OR = 1.01, 95% CI: 1.00–1.02, P = .011) and social interaction (OR = 1.01, 95% CI: 1.00–1.03, P = .002). There were no significant variations over time for feeding, locomotion, and transfer mobility.

Conclusions: Trends for SATBI served by Pennsylvania's established trauma system showed increases in rates but substantial reductions in mortality and significant improvements in functional outcomes at discharge for expression and social interaction.

Departments of Surgery (Drs Sánchez, Peitzman, and Puyana) and Statistics (Dr Krafty), University of Pittsburgh, Pittsburgh, Pennsylvania; CISALVA Institute, Universidad del Valle, Cali, Colombia (Dr Sánchez); Injury Prevention Research Unit, University of Otago, Dunedin, New Zealand (Dr Weiss); and Department of Neurosciences, South Colombian University, Critical Care Unit, Neiva University Hospital, Neiva, Colombia (Dr Rubiano).

Corresponding Author: Álvaro I Sánchez, MD, MS, Department of Surgery, University of Pittsburgh, 3550 Terrace St, A-1305 SCAIF, Pittsburgh, PA 15213 (;

This study was funded by grant 1 D43 TW007560 01 from Fogarty International Center of the National Institutes of Health. The funder had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

The Pennsylvania Trauma Outcome Study database was provided by the Pennsylvania Trauma Systems Foundation, Mechanicsburg, Pennsylvania. The foundation specifically disclaims responsibility for any analyses, interpretations, or conclusions. This project was reviewed by the institutional review board at the University of Pittsburgh. On the basis of the information we provided, this project met all the necessary criteria for an exemption and was hereby designated as exempt.

The authors thank Dr Anbesaw Selassie (Medical University of South Carolina), Dr Mark Roberts (University of Pittsburgh, USA), and Dr Matthew Rosengart (University of Pittsburgh, USA) for their detailed comments and useful suggestions on the analysis and manuscript. We thank the research committee of the Pennsylvania Trauma Systems Foundation for providing the requested data points. We also thank the hospitals contributing to the Pennsylvania Trauma Outcome Study. We declared that we have no conflicts of interest.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.