The incidence and determinants of traumatic brain injury deaths occurring outside hospital in Australia

Objective: To identify the determinants of death occurring outside of hospital following moderate to severe traumatic brain injury (msTBI) across Australia. 

Methods: Design, setting: Retrospective observational study using National Coronial Information System (NCIS) data. Participants: People who died during the five-year study period between 2015 and 2020 and were recorded in the NCIS as having intracranial injury as a cause or contributor to death. Major outcome measures: The primary outcome was the location of death, specifically whether death occurred outside an acute hospital setting. 

Results: There were 3751 deaths with msTBI, of which 1064 (28.4%) occurred outside of an acute hospital setting and 605 (16.1%) occurred outside any medical service. The odds of death occurring outside hospital were lower for male patients (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.5–0.7), penetrating injuries (OR 5.2, 95% CI: 3.0–8.9) and highest in the Northern Territory followed by Queensland. The odds of death occurring outside any medical service area (e.g. hospital, rehabilitation, nursing home) were higher for: younger adults (OR 3.6, 95% CI: 1.0–12.7), those with penetrating injuries (OR 8.9, 95% CI: 4.5–17.3), and where the time between injury and death was less than 24 h. The odds of death outside any medical service area were less for people with msTBI in South Australia (OR 0.1, 95% CI 0.0–0.2). 

Conclusion: Approximately, one in six msTBI deaths occurred outside of any medical service area. Opportunities exist to improve access to emergency care for people sustaining msTBI across Australia.