Möttönen J, Ponkilainen V T, Iverson G L, Cassidy J D, Luoto T, Mattila V M, Kuitunen I
Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland.
Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland.
Public Health. 2024 Nov;236:125-132. doi: 10.1016/j.puhe.2024.07.025. Epub 2024 Aug 24.
To assess all-cause mortality and suicides after pediatric traumatic brain injury (pTBI).
We conducted population-based historical cohort study using three nationwide registers from 1998 to 2018 in Finland. All patients that were the age of 0-17 at the time of the pTBI were included. The reference group consisted of children with ankle or wrist fractures. We used Kaplan-Meier and restricted mean survival time (RMST) analysis with 95% confidence intervals (CI) to compare all-cause mortality and suicides between groups.
After 20 years of follow-up, there were 479 deaths in the pTBI group (0.67% of 71,963) and 306 deaths in the reference group (0.47% of 64,848). In the pTBI group, 28.6% of the deaths occurred after the first follow-up year, compared to 2.6% in the reference group. In all-cause mortality, survival time was slightly less in the pTBI group with age and gender adjustment throughout the follow-up period [20-year RMST ratio: 0.995; CI (0.994-0.996)]. The leading manners of death were suicides (pTBI group = 28.4%; reference group = 45.5%) and traffic collisions (pTBI group = 37.4%; reference group = 20.8%). Age and gender-adjusted survival time was slightly less for those with suicide as a manner of death in the pTBI group [10-year RMST ratio: 0.999; CI (0.999-0.999); 20-year RMST ratio: 0.999; CI (0.998-0.999)].
Children and adolescents who sustained a TBI have slightly lower long-term survival time for all-cause mortality, most of which occurs during the first year following injury. There is no clinically meaningful difference in deaths by suicide between the two injury groups.
评估小儿创伤性脑损伤（pTBI）后的全因死亡率和自杀情况。
我们利用芬兰1998年至2018年的三个全国性登记册进行了基于人群的历史性队列研究。纳入所有在pTBI发生时年龄为0至17岁的患者。参照组由踝关节或腕关节骨折的儿童组成。我们使用Kaplan-Meier法和受限平均生存时间（RMST）分析以及95%置信区间（CI）来比较两组之间的全因死亡率和自杀情况。
经过20年的随访，pTBI组有479例死亡（71963例中的0.67%），参照组有306例死亡（64848例中的0.47%）。在pTBI组中，28.6%的死亡发生在首次随访年后，而参照组为2.6%。在全因死亡率方面，在整个随访期间进行年龄和性别调整后，pTBI组的生存时间略短[20年RMST比率：0.995；CI（0.994 - 0.996）]。主要死亡方式为自杀（pTBI组 = 28.4%；参照组 = 45.5%）和交通碰撞（pTBI组 = 37.4%；参照组 = 20.8%）。在pTBI组中，以自杀为死亡方式的患者，经年龄和性别调整后的生存时间略短[10年RMST比率：0.999；CI（0.999 - 0.999）；20年RMST比率：0.999；CI（0.998 - 0.999）]。
遭受脑损伤的儿童和青少年全因死亡率的长期生存时间略短，其中大部分死亡发生在受伤后的第一年。两组损伤患者在自杀死亡方面没有临床意义上的差异。
