Impact of grouping complications on mortality in traumatic brain injury: A nationwide population-based study

doi:10.1371/journal.pone.0190683

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Title:	Impact of grouping complications on mortality in traumatic brain injury: A nationwide population-based study
Authors:	Ho, Chung-Han Liang, Fu-Wen Wang, Jhi-Joung Chio, Chung-Ching Kuo, Jinn-Rung
Contributors:	Chi Mei Med Ctr, Dept Med Res Chia Nan Univ Pharm & Sci, Dept Hosp Hlth Care Adm Natl Cheng Kung Univ, Coll Med, Res Ctr Hlth Data Natl Cheng Kung Univ, Coll Med, Dept Publ Hlth Chi Mei Med Ctr, Dept Neurosurg Southern Taiwan Univ Sci & Technol, Dept Biotechnol
Keywords:	Insurance Research Database Acute Myocardial-Infarction Artificial Neural-Network In-Hospital Mortality Risk-Factors Sleep Disorders Ischemic-Stroke Taiwan Care Epidemiology
Date:	2018-01-11
Issue Date:	2019-11-15 15:47:25 (UTC+8)
Publisher:	PUBLIC LIBRARY SCIENCE
Abstract:	Traumatic brain injury (TBI) is an important health issue with high mortality. Various complications of physiological and cognitive impairment may result in disability or death after TBI. Grouping of these complications could be treated as integrated post-TBI syndromes. To improve risk estimation, grouping TBI complications should be investigated, to better predict TBI mortality. This study aimed to estimate mortality risk based on grouping of complications among TBI patients. Taiwan's National Health Insurance Research Database was used in this study. TBI was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes: 801-804 and 850-854. The association rule data mining method was used to analyze coexisting complications after TBI. The mortality risk of post-TBI complication sets with the potential risk factors was estimated using Cox regression. A total 139,254 TBI patients were enrolled in this study. Intracerebral hemorrhage was the most common complication among TBI patients. After frequent item set mining, the most common post-TBI grouping of complications comprised pneumonia caused by acute respiratory failure (ARF) and urinary tract infection, with mortality risk 1.55 (95% C. I.: 1.51-1.60), compared with those without the selected combinations. TBI patients with the combined combinations have high mortality risk, especially those aged < 20 years with septicemia, pneumonia, and ARF (HR: 4.95, 95% C. I.: 3.55-6.88). We used post-TBI complication sets to estimate mortality risk among TBI patients. According to the combinations determined by mining, especially the combination of septicemia with pneumonia and ARF, TBI patients have a 1.73-fold increased mortality risk, after controlling for potential demographic and clinical confounders. TBI patients aged<20 years with each combination of complications also have increased mortality risk. These results could provide physicians and caregivers with important information to increase their awareness about sequences of clinical syndromes among TBI patients, to prevent possible deaths among these patients.
???metadata.dc.relation.uri???:	http://dx.doi.org/10.1371/journal.pone.0190683
Relation:	Plos One, v.13, n.1, e190683
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Periodical Articles

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