After Traumatic Brain Injury, Risk of Premature Death Triples

Traumatic brain injury has increasingly been the focus of attention due to its links with motor vehicle accidents, falls, contact sports such as football, as well as military combat. In my law practice in Atlanta as well as in my own personal life, I have seen many times the catastrophic effects a traumatic brain injury can have. However, not all of these injuries are the same nor do they produce the same symptoms.

According to a new study published online yesterday, traumatic brain injury can affect the length of life as well as its quality.  A new study published in JAMA Psychiatry suggests that people who have suffered a traumatic brain injury appear to have a much higher risk of dying prematurely. The study, headed by Seena Fazel, M.D., a senior research fellow in the Department of Psychiatry at the University of Oxford in England, suggests that people who experienced a traumatic brain injury were three times more likely to die prematurely than were matched control subjects.

“After a traumatic brain injury, patients have a threefold increased risk of dying prematurely,” said lead researcher Dr. Fazel. “Fifty percent of the early deaths are due to either accident or suicide or being assaulted,” he said. “That seems to be related to psychiatric illness and substance abuse.”

This new study is based on data from 218,300 people in Sweden who were born in 1954 or later and who were diagnosed with traumatic brain injury sometime between 1969 and 2009. The researchers looked at the death rate and cause of death of this population six or more months after the traumatic brain injury, and compared it with the general population as well as siblings of the patients with traumatic brain injury.

Fazel believed that after a traumatic brain injury, patients need to be monitored for risk factors that may put them at risk for dying prematurely especially problems like psychiatric illness and substance abuse which can be treated.

Fazel also suggests that these risks might be a particular problem for soldiers and athletes who have had traumatic brain injury. “A large number of vets have suffered traumatic brain injuries, and we know a lot of vets are dying from suicide. Traumatic brain injury may be one of the factors that increase their risk,” he said.

While the study found an association between TBI and early death, it did not establish a cause-and-effect relationship leaving some experts wary whether the study noted personality and behavioral characteristics that could be leading to the participants’ early death.

“The people that are dying earlier have personality characteristics that make them vulnerable to have brain injury,” said Dr. Robert Robinson, a professor of psychiatry at the University of Iowa and author of an editorial on the matter. Another expert agreed.

“It makes sense that people who suffer a brain injury are more likely to repeat behavior over time…a lot has to do with behaviors that would get them involved in brain injuries in the first place,” said Dr. Jamie Ullman, director of neurotrauma at North Shore University Hospital in Manhasset, New York.

While risky behavior can put people at risk for brain injury and premature death, other major concerns that experts have are suicide and depression that can occur after a traumatic brain injury.

Among the 218,000 patients, more than 11,000 died prematurely after their brain injury. Of those who dies, 21.5 percent died six months or later after the injury. The researchers compared the death rate of those with brain injury with more than 2 million people who hadn’t had a brain injury.

The investigators found an increased risk of dying prematurely among patients who survived six months after a brain injury compared with those who didn’t have one. The increased risk of dying remained the same for at least five years after the injury. These patients were also at risk of early death if they had psychiatric conditions or were substance abusers, the study found.

Ken Shigley is past president of the State Bar of Georgia (2011-12), double board certified in Civil Trial Advocacy and Civil Pretrial Advocacy by the National Board of Legal Specialty Certification, and lead author of Georgia Law of Torts: Trial Preparation and Practice.  His Atlanta-based civil trial practice is focused on representation of plaintiffs in cases of castastrophic personal injury and wrongful death.