D'Alonzo Bernadette A, Bretzin Abigail C, Morse Rebecca B, Canelón Silvia P, Wiebe Douglas J, Schneider Andrea L C, Boland Mary Regina
Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Neurotrauma Rep. 2025 Aug 1;6(1):613-623. doi: 10.1177/08977151251361700. eCollection 2025.
The objective of this retrospective cohort study was to evaluate mortality risk over five years among 6,432 female patients with a health care encounter diagnosis of TBI from hospitals and outpatient clinics within a university health system. We used TBI severity, defined by the Centers for Disease Control and Department of Defense/Veterans Affairs: mild, moderate/severe/penetrating, indeterminate severity. To determine patient death, we used death in a Penn Medicine facility and linkage to the Social Security Death Index. We used Cox proportional hazards models adjusted for age at the time of TBI diagnosis, race, and encounter type to estimate associations of TBI severity with mortality risk. We evaluated interactions with encounter type and age, and stratified results by inpatient/outpatient and age group (≥65 years). Median age was 47 years (25th-75th percentiles: 29-63). Patients were most commonly self-reported White race ( = 4,126, 64.0%), and diagnosed at an outpatient encounter ( = 5,099, 79.3%; among them, 1-2% urgent/emergent). Median follow-up time was 4.22 years (IQR, 2.3-4.9 years). Overall, 2.9% ( = 185) of patients died within five years of injury. Compared with mild TBI, mortality risk over five years was 2.06 times higher (95% CI = 1.27-3.33) for moderate/severe/penetrating TBI, and 1.54 times higher (95% CI = 0.98-2.42) for indeterminate TBI. Associations were attenuated among females with inpatient encounter type and those aged 65 years or older. Our results demonstrate that TBI severity affects survival among females, and this differs by encounter type and age. Findings motivate future, more focused research into the dynamics of TBI among females.
这项回顾性队列研究的目的是评估在一个大学医疗系统内的医院和门诊诊所中，6432名有创伤性脑损伤（TBI）医疗诊断的女性患者在五年内的死亡风险。我们采用了由疾病控制中心以及国防部/退伍军人事务部定义的TBI严重程度：轻度、中度/重度/穿透性、严重程度不确定。为了确定患者是否死亡，我们利用了宾夕法尼亚大学医学中心设施内的死亡情况以及与社会保障死亡指数的关联。我们使用Cox比例风险模型，对TBI诊断时的年龄、种族和就诊类型进行了调整，以估计TBI严重程度与死亡风险之间的关联。我们评估了与就诊类型和年龄的相互作用，并按住院/门诊和年龄组（≥65岁）对结果进行了分层。中位年龄为47岁（第25 - 75百分位数：29 - 63岁）。患者最常自我报告为白人（n = 4126，64.0%），且诊断于门诊就诊（n = 5099，79.3%；其中1 - 2%为紧急/急诊）。中位随访时间为4.22年（四分位间距，2.3 - 4.9年）。总体而言，2.9%（n = 185）的患者在受伤后五年内死亡。与轻度TBI相比，中度/重度/穿透性TBI的五年死亡风险高2.06倍（95%置信区间 = 1.27 - 3.33），严重程度不确定的TBI高1.54倍（95%置信区间 = 0.98 - 2.42）。在住院就诊类型的女性和65岁及以上的女性中，这种关联减弱。我们的结果表明，TBI严重程度会影响女性的生存情况，并且这在就诊类型和年龄方面存在差异。这些发现促使未来针对女性TBI动态进行更有针对性的研究。
