Analysis of influencing factors of traumatic brain injury outcome at discharge based on electronic health record home pages: 4058 cases

Abstract

Objective To summarize the characteristics and changes of traumatic brain injury (TBI) in Tongzhou district of Beijing with the rapid development of social economy, in order to provide the theoretical basis for adjustment of the prevention and treatment strategies in high risk population. Methods The home pages of electronic health record (EHR) of patients with TBI from December 1, 2004 to October 22, 2018 were automatically extracted from the EHR of Beijing Luhe Hospital, Capital Medical University. The clinical characteristics were retrospectively analyzed, and the risk factors related to death at discharge were screened by univariate and multivariate forward Logistic regression analysis. Results A total of 4058 patients with TBI were screened out, of which 3683 cases (90.76%) survived and 375 cases (9.24%) died at discharge. The mortality at discharge was significantly different among different age (χ² = 51.526, P = 0.000), causes of injury (χ² = 82.349, P = 0.000), treatment modalities (χ² = 186.270, P = 0.000) and hospital length (χ² = 9.842, P = 0.000). The mortality of patients aged 45-64, 65-74 and ≥ 75 years was higher than that of patients aged 15-24 and 25-44 years (P < 0.01, for all), and the mortality of patients aged ≥ 75 years was higher than that of patients aged 45-64 years (P = 0.001). The mortality of patients with traffic accident injury was higher than that of fall injury (P = 0.000), and the mortality of patients with traffic accident injury, fall injury and other cases was higher than that of violent injury (P = 0.000, for all). The mortality of patients received neurosurgery and non-neurosurgery was higher than that of conservative treatment (P = 0.000, for all). The mortality of patients with hospital lengh of 1-14 d was higher than that of 15-30 d and > 30 d (P = 0.000, for all). Logistic regression analysis showed that 45-64 years old (OR = 2.285, 95%CI: 1.428-3.657; P = 0.001), 65-74 years old (OR = 4.025, 95%CI: 2.334-6.941; P = 0.000), ≥ 75 years old (OR = 5.757, 95%CI: 3.317-9.991; P = 0.000), hospital admission in year 2007-2010 (OR = 1.856, 95%CI: 1.376-2.504; P = 0.000), treatment with neurosurgery (OR = 6.465, 95%CI: 4.991-8.376; P = 0.000) and non-neurosurgical procedures (OR = 3.389, 95%CI: 1.828 - 6.283; P = 0.000), hospital length 1- 14 d (OR = 6.023, 95%CI: 3.822-9.490; P = 0.000) were risk factors for death at discharge of TBI patients, and violent injury was a protective factor for death at discharge (OR = 0.245, 95%CI: 0.112-0.537; P = 0.000). Conclusions The mortality of TBI is still high, patients over 45 years, hospital admission in year 2007-2010, traffic accident injury, treatment with neurosurgery and non⁃neurosurgery, and hospital length of 1-14 d had a higher mortality at discharge.

doi：10.3969/j.issn.1672⁃6731.2022.07.010