Predictors of in-hospital mortality following hypoxic-ischemic brain injury: a population-based study

ABSTRACT

Objective: To identify predictors of in-hospital mortality following Hypoxic-Ischemic Brain Injury (HIBI) using the Anderson Behavioral Model.

Design and Setting: Population based retrospective cohort study in Ontario, Canada with data collected between 1 April 2002 and 31 March 2017.

Patients: Adult patients aged 20 years and older with HIBI-related acute care admission were identified in the health administrative data. Multivariable cox proportional hazard regression models were used to identify predisposing, need and enabling factors that predict in-hospital mortality.

Results: Of the 7492 patients admitted to acute care with HIBI, the in-hospital mortality rate was 71%. The predisposing factors associated with mortality were female sex (HR, 1.16; 95% CI, 1.10–1.23) and older age (65–79 vs. 20–34: HR, 1.17; 95% CI, 1.02–1.35). The need factors associated with mortality were the presence of COPD (HR, 1.10; 95% CI, 1.02–1.17), psychiatric illness (HR, 1.13; 95% CI, 1.05–1.20) injury due to cardiac illness (HR, 1.19; 95% CI, 1.12–1.26) and longer emergency department length of stay. Having spending any time in an alternate level of care and the application of tracheotomy procedures were found to reduce mortality.Conclusions: The acute/critical care centers need to consider these findings to adopt prevention strategies targeting reduced in-hospital mortality.

KEYWORDS:

• Hypoxic ischemic brain injury
• hospital mortality
• cardiac
• cox proportional regression

Acknowledgments

This study made use of de-identified data from the ICES Data Repository, which is managed by the Institute for Clinical Evaluative Sciences with support from its funders and partners: Canada’s Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research and the Government of Ontario. The opinions, results, and conclusions reported are those of the authors. No endorsement by ICES or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI. The authors thank the ICES for providing the data required for the study and the staff of TRI-UHN for their support. The authors also thank the CIHR for providing funding (Funding Reference Number: PJT-153129) for this study. We would like to acknowledge patient collaborator Michelle Bartlett for her contributions in interpreting the findings for this study.

Authors Contributions

Binu Jacob, David Stock, Vincy Chan, Angela Colantonio, and Nora Cullen conceptualized and designed the study. Binu Jacob and David Stock formulated the methodology. Binu Jacob carried out the statistical analyses and drafted the manuscript. David Stock, Vincy Chan, Angela Colantonio, and Nora Cullen each contributed significant critical analysis, helped with the interpretation of findings and editing the manuscript. All authors approved the final manuscript version.

Declaration of Interest

The authors report no conflicts of interest. This study was funded by the CIHR (Funding Reference Number: PJT-153129).

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research [201610PJT-377880-PJT-ADHD-136768].