San Francisco VA Health Care System, San Francisco, California, USA.
Department of Psychiatry, University of California, San Francisco, California, USA.
Brain Inj. 2020 Feb 23;34(3):328-334. doi: 10.1080/02699052.2019.1701708. Epub 2019 Dec 11.
: Evidence guiding suicide-prevention efforts in patients with traumatic brain injury (TBI) is imperative. We evaluated association between TBI and risk of death by drug overdose and firearms, including suicide and unintentional injury.: Cohort study of all patients 18 years and older in Veterans Health Administration databases from October 1, 2001 to December 31, 2014 with TBI diagnosis (N = 230,200), and age-matched 1:1 to random sample of patients without TBI (N = 230,200).: After adjusting for demographics, comorbidities, and accounting for competing risk of other deaths, hazard ratios for death by drug overdose were 1.40 (95% CI = 1.21-1.62) for mild TBI and 1.51 (95% CI = 1.31-1.74) for moderate-to-severe TBI, while hazard ratios for death by firearms were 1.09 (95% CI = 0.89-1.33) for mild TBI and 1.33 (95% CI = 1.10-1.60) for moderate-to-severe TBI. Risk of overdose death due to TBI severity was mainly observed for middle and older age groups.: Findings suggest that veterans with mild and moderate-to-severe TBI are at increased risk of death by drug overdose and firearms, with overdose risk heightened with age. Data indicate that prevention efforts in patients with TBI include targeted means reduction.
有创伤性脑损伤 (TBI) 的患者需要有指导自杀预防工作的证据。我们评估了 TBI 与药物过量和枪支（包括自杀和非故意伤害）导致的死亡风险之间的关系。
这是一项对 2001 年 10 月 1 日至 2014 年 12 月 31 日期间退伍军人健康管理局数据库中所有 18 岁及以上患者的队列研究，包括 TBI 诊断患者（N=230200 例）和年龄匹配的无 TBI 患者的随机样本 1:1（N=230200 例）。
在调整了人口统计学因素、合并症，并考虑了其他死亡的竞争风险后，药物过量导致死亡的风险比轻度 TBI 为 1.40（95%CI=1.21-1.62），中度至重度 TBI 为 1.51（95%CI=1.31-1.74），而枪支导致死亡的风险比轻度 TBI 为 1.09（95%CI=0.89-1.33），中度至重度 TBI 为 1.33（95%CI=1.10-1.60）。TBI 严重程度导致的过量死亡风险主要见于中老年人组。
研究结果表明，轻度和中度至重度 TBI 的退伍军人因药物过量和枪支导致死亡的风险增加，且随着年龄的增长，过量死亡风险增加。数据表明，TBI 患者的预防工作应包括有针对性的减少措施。
