In 2000, Sir Graham Teasdale and his colleagues from Glasgow wrote an article entitled “Disability in Young People and Adults One Year After Head Injury: Perspective Cohorts Study,” in the British Medical Journal (BMJ 2000; 320:1631-5). There, Dr. Teasdale reported that those with a mild traumatic brain injury had a significantly elevated rate of disability one year after injury. In the 2006 issue of The Journal of Neurology, Neurosurgery and Psychiatry, Dr. Teasdale and his colleagues concluded, after following this same cohort for 5-7 more years , that “even after what was judged conventionally to be a minor head injury was followed by disability in a high proportion of survivors.” Similar findings were again reported by Sir Teasdale in his keynote speech at the 2010 World Congress on Traumatic Brain Injury sponsored by the International Brain Injury Association.
In a new paper, hot of the press, again published in The Journal of Neurology, Neurosurgery and Psychiatry, Dr. Teasdale, Thomas McMillian and their colleagues investigated the mortality rate of persons with mild, moderate and severe traumatic brain injury. Neurol, Neurosurg, Psychiatry 2011; 82:931-935.
The researchers looked at a cohort group of 767 patients with brain injury and compared that with two case control groups, matched for age, gender and deprivation. One control group, consisted of the community population while the second was matched for duration of hospital admission following non-brain injury.
The researchers found that two fifths of the brain injury cohort had died over the 13 year period. However, the death rate of 30.99 per thousand per year was much higher than in community controls (13.72 per one thousand per year). More than one year after injury, the death rate in younger adults (15-54) was much higher than in community controls (17.36 vs. 2.36 per thousand per year), whereas in older adults the difference was more marginal (61.47 vs. 42.36). The researchers found that the death rate was elevated not only for those who sustained severe brain injury, but for those who sustained a mild traumatic brain injury as well. The researchers found “the severity of head injury was not associated with survival outcome beyond the first year after injury. Even when head injury was classified as mild by the Glasgow Coma Scale, death rate was more than twice as high as in community controls.”
The researchers concluded that traumatic brain injury is associated with increased vulnerability to death from a variety of causes for at least 13 years after hospital admission. There is a need to understand how brain injury influences mortality, particularly in younger adults and after mild brain injury.