Alinani Anwar, Mills Brianna, Gause Emma, Vavilala Monica S, Lele Abhijit V
Anesthesiology and Pain Medicine, Harborview Medical Center, Seattle, USA.
Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Seattle, USA.
Cureus. 2022 Jul 25;14(7):e27228. doi: 10.7759/cureus.27228. eCollection 2022 Jul.
Introduction Higher federal research funding levels may improve patient outcomes. We examined this relationship between traumatic brain injury (TBI) funding and all-cause in-hospital TBI-related mortality. Methods Using an ecological series analysis, we examined the linear trend in both clinical TBI research funding in year 2000 United States dollars ($) (National Institutes of Health [NIH] RePORTER) and in-hospital isolated TBI mortality among patients aged 15 and older (National Trauma Data Bank [NTDB], TBI-related ICD-9 or ICD-10 code, abbreviated head injury score >2 and body region score <2 with ICU admission) between 2007-2015 with data from centers contributing all years of data for the study period. Linear regression was used to assess the relationship between mortality rate and total funding, lagged one to three years, both overall and within ten-year age groups. Results The mean annual NIH-TBI research funding was $64.36 million (lowest: 2008; $48.79 million, highest: 2015; $71.42 million). 192,597 encounters of patients 15 years and older, predominantly male (67.5%) and with polytrauma (59.9%), were included. There was no statistically significant reduction in in-hospital TBI-related mortality (14.15% in 2007 to 13.36% in 2015) for the cohort overall, but the mortality rate decreased for patients over 55 years. The greatest mortality reduction occurred in patients 85 years and older (-62.35, 95% CI -92.45-32.25), followed by patients 75-84 years (-44.41, 95% CI -61.72, -27.09), patients 65-74 years (-47.60, 95% CI -67.39, -27.81), and patients 55-64 years of age (-15.15, 95% CI -27.59, -2.72). During the study period, annual NIH funding for TBI varied from the lowest level of $48.79 million (in 2007) to the highest level of $77.34.43 million (in 2005). There was no association between funding in the previous three years and the in-hospital TBI-related mortality rate. Conclusion This study found a variable pattern in NIH funding for clinical TBI research and a contemporaneous reduction in moderate-severe TBI-related deaths only for those aged 55 years and older, but no association between funding and mortality.
引言 更高的联邦研究资金水平可能会改善患者的治疗效果。我们研究了创伤性脑损伤（TBI）资金与所有原因导致的住院TBI相关死亡率之间的这种关系。方法 使用生态序列分析，我们研究了以2000年美元（$）计算的临床TBI研究资金（美国国立卫生研究院[NIH]报告系统）以及15岁及以上患者的住院孤立性TBI死亡率（国家创伤数据库[NTDB]，TBI相关的ICD-9或ICD-10编码，缩写头部损伤评分>2且身体区域评分<2并入住重症监护病房）在2007 - 2015年期间的线性趋势，数据来自在研究期间提供所有年份数据的中心。线性回归用于评估死亡率与滞后一至三年的总资金之间的关系，包括总体情况以及在十年年龄组内的情况。结果 美国国立卫生研究院每年的TBI研究资金平均为6436万美元（最低：2008年；4879万美元，最高：2015年；7142万美元）。纳入了192597例15岁及以上的患者，主要为男性（67.5%）且有多发伤（59.9%）。总体队列中，住院TBI相关死亡率没有统计学上的显著降低（从2007年的14.15%降至2015年的13.36%），但55岁以上患者的死亡率有所下降。最大的死亡率降低发生在85岁及以上的患者中（-62.35，95%置信区间-92.45 - 32.25），其次是75 - 84岁患者（-44.41，95%置信区间-61.72，-27.09）、65 - 74岁患者（-47.60，95%置信区间-67.39，-27.81）以及55 - 64岁患者（-15.15，95%置信区间-27.59，-2.72）。在研究期间，美国国立卫生研究院每年用于TBI的资金从最低水平的4879万美元（2007年）到最高水平的7734.43万美元（2005年）不等。前三年的资金与住院TBI相关死亡率之间没有关联。结论 本研究发现美国国立卫生研究院用于临床TBI研究的资金模式存在变化，并且仅55岁及以上的中度至重度TBI相关死亡人数同期有所减少，但资金与死亡率之间没有关联。
