University of Oulu

Luostarinen, T., Vehviläinen, J., Lindfors, M. et al. Trends in mortality after intensive care of patients with traumatic brain injury in Finland from 2003 to 2019: a Finnish Intensive Care Consortium study. Acta Neurochir 164, 87–96 (2022). https://doi.org/10.1007/s00701-021-05034-4

Trends in mortality after intensive care of patients with traumatic brain injury in Finland from 2003 to 2019 : a Finnish Intensive Care Consortium study

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Author: Luostarinen, Teemu1; Vehviläinen, Juho2; Lindfors, Matias2;
Organizations: 1Anaesthesiology and Intensive Care, Hyvinkää Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
2Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
3Department of Anaesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
4Department of Perioperative Services, Intensive Care and Pain Management, Turku University Hospital & University of Turku, Turku, Finland
5Department of Intensive Care and Emergency Medicine Services, Tampere University Hospital & University of Tampere, Tampere, Finland
6Department of Intensive Care, Oulu University Hospital & University of Oulu, Oulu, Finland
7Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.5 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2022030822335
Language: English
Published: Springer Nature, 2022
Publish Date: 2022-03-08
Description:

Abstract

Background: Several studies have suggested no change in the outcome of patients with traumatic brain injury (TBI) treated in intensive care units (ICUs). This is mainly due to the shift in TBI epidemiology toward older and sicker patients. In Finland, the share of the population aged 65 years and over has increased the most in Europe during the last decade. We aimed to assess changes in 12-month and hospital mortality of patients with TBI treated in the ICU in Finland.

Methods: We used a national benchmarking ICU database (Finnish Intensive Care Consortium) to study adult patients who had been treated for TBI in four tertiary ICUs in Finland during 2003–2019. We divided admission years into quartiles and used multivariable logistic regression analysis, adjusted for case-mix, to assess the association between admission year and mortality.

Results: A total of 4535 patients were included. Between 2003–2007 and 2016–2019, the patient median age increased from 54 to 62 years, the share of patients having significant comorbidity increased from 8 to 11%, and patients being dependent on help in activities of daily living increased from 7 to 15%. Unadjusted hospital and 12-month mortality decreased from 18 and 31% to 10% and 23%, respectively. After adjusting for case-mix, a reduction in odds of 12-month and hospital mortality was seen in patients with severe TBI, intracranial pressure monitored patients, and mechanically ventilated patients. Despite a reduction in hospital mortality, 12-month mortality remained unchanged in patients aged ≥ 70 years.

Conclusion: A change in the demographics of ICU-treated patients with TBI care is evident. The outcome of younger patients with severe TBI appears to improve, whereas long-term mortality of elderly patients with less severe TBI has not improved. This has ramifications for further efforts to improve TBI care, especially among the elderly.

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Series: Acta neurochirurgica
ISSN: 0001-6268
ISSN-E: 0942-0940
ISSN-L: 0001-6268
Volume: 164
Issue: 1
Pages: 87 - 96
DOI: 10.1007/s00701-021-05034-4
OADOI: https://oadoi.org/10.1007/s00701-021-05034-4
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
Funding: The study was supported by grants from Finska Läkaresällskapet, Svenska Kulturfonden, and Medicinska Understödsföreningen Liv & Hälsa. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright information: © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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