Long-term causes of death after traumatic brain injury

Objective: To determine which causes of death are more frequent in persons with traumatic brain injury (TBI), and by how much, compared with the gener al population. Our focus was the period beginning 1 yr after injury. Design: Subjects were 2320 Californians with long-term mental disability af ter a TBI at age 10 yr or more, followed up between 1988 and 1997. The unit s of study were person-years, each linked to the subject's age, gender, lev el of ambulation, time since injury, and cause of death (if any) for the sp ecific year. Observed numbers of cause-specific deaths were compared with n umbers expected according to general population mortality rates. Results: Mortality was higher between 1.0 and 5.0 yr postinjury than after 5.0 yr and was strongly related to reduced mobility. Death rates were eleva ted for circulatory diseases, respiratory diseases, choking/suffocation, an d seizures, with seizure deaths being relatively frequent, even among the m ost ambulatory. Conclusions: Death rates for several causes are elevated in persons with lo ng-term sequelae of TBI, The increased risk of choking/suffocation should b e of interest to caregivers. Life expectancy seems to be reduced, even for patients who are fully ambulatory.