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Mortality After Surviving Traumatic Brain Injury: Risks Based on Age Groups

Harrison-Felix, Cynthia PhD; Kolakowsky-Hayner, Stephanie A. PhD, CBIST; Hammond, Flora M. MD; Wang, Roberta MD; Englander, Jeffrey MD; Dams-O'Connor, Kristen PhD; Kreider, Scott E. D. MS; Novack, Thomas A. PhD; Diaz-Arrastia, Ramon MD, PhD

Journal of Head Trauma Rehabilitation: November/December 2012 - Volume 27 - Issue 6 - p E45–E56
doi: 10.1097/HTR.0b013e31827340ba
Original Articles

Objective: To assess mortality, life expectancy, risk factors, and causes of death by age groups among persons who received inpatient traumatic brain injury (TBI) rehabilitation.

Design: Prospective cohort study.

Setting: The TBI Model Systems.

Participants: 8573 individuals injured between 1988 and 2009, with survival status per December 31, 2009, determined.

Interventions: Not applicable.

Main Outcome Measures: Standardized mortality ratio, life expectancy, and cause of death.

Results: Moderate-severe TBI increases risk of mortality compared with the general population in all age groups, with the exception of those 85 years or older at the time of injury. Teenagers to middle-aged adults are at particular risk. Risk factors for death varied by age group and included gender, marital and employment status, year and cause of injury, and level of disability. External causes of death predominate in younger groups. For the youngest male participants in the sample, longevity was reduced up to 16 years.

Conclusion: Risk factors and causes of death varied considerably by age group for individuals with moderate-severe TBI who were receiving acute care rehabilitation. Moderate-severe TBI is a chronic health condition.

Craig Hospital, Englewood, Colorado (Dr Harrison-Felix and Mr Kreider); Santa Clara Valley Medical Center, Rehabilitation Research Center (Dr Kolakowsky-Hayner), Santa Clara Valley Medical Center (Drs Wang and Englander), San Jose, California; Carolinas Rehabilitation, Carolinas HealthCare System, Charlotte, North Carolina, and Indiana University School of Medicine, Indianapolis (Dr Hammond); Mount Sinai School of Medicine, New York (Dr Dams-O'Connor); University of Alabama at Birmingham, Birmingham (Dr Novack); and Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Diaz-Arrastia).

Corresponding Author: Stephanie A. Kolakowsky-Hayner, PhD, CBIST, Rehabilitation Research Center, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128 (

This work was supported in part by grants from the National Institute on Disability and Rehabilitation Research (NIDRR), Office of Special Education Services, Department of Education grant numbers: H133A070038, HD133A020526, H133A070042, H133A070039, H133A070033, H133A110006, H133A070022.

The contents of the study were developed under grants from the Department of Education, NIDRR, as specified under the Source of Funding section. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government. The authors thank the research participants, research assistants, and all project staff for their assistance in the success of this endeavor. In addition, the authors acknowledge the continued support of the project officers and program manager at NIDRR.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.