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Mechanism of injury predicts outcome in traumatic brain injury

      Objective: To determine the independent effect of Mechanism of Injury (MOI) on risk-adjusted survival in Traumatic Brain Injury (TBI). Methods: Patient Population; TBI hospital discharges (N=178,642 identified by ICD-9 head injury diagnosis codes) in the 1991-2001 New York Statewide Planning and Research Cooperative System (SPARCS) dataset. MOI was determined by ICD-9 E-Codes. TBI severity was categorized by the Relative Head Injury Severity Score (RHISS). Statistical Analysis: Stepwise logistic regression was used to predict mortality based on: age, gender, ICD-9 injury severity score (ICISS), RHISS, insurance status and MOI. Results: 10,786 (6.1%) TBI patients died. Area under the Receiver Operating Characteristic Curve for mortality prediction was 0.93. MOI was an independently significant predictor (p<.001). The table shows Odds Ratios (OR) for death for each MOI, with motor vehicle crash (MVC) as the reference group (OR= 1). Relative to MVC, all MOIs except bicycle crashes and sports related injuries were associated with a significantly higher probability of death. Gunshots and Burns were associated with the highest odds of death relative to MVC. Conclusion: Mechanism of injury plays a role in determining the outcome of traumatic brain injury that is independent of injury severity and demographic factors. Greater understanding of mechanism-related prognostic factors may lead to improved outcomes and help guide preventative measures.
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