scholarly journals Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital

2017 ◽  
Vol 27 (6) ◽  
pp. 445-454 ◽  
Author(s):  
Lu Han ◽  
Matt Sutton ◽  
Stuart Clough ◽  
Richard Warner ◽  
Tim Doran
Keyword(s):  
Hospital Mortality ◽  
Mortality Risk ◽  
Mortality Rates ◽  
Absolute Difference ◽  
Night Time ◽  
Out Of Hours ◽  
Percentage Points ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Over Time

BackgroundEmergency hospital admission on weekends is associated with an increased risk of mortality. Previous studies have been limited to examining single years and assessing day—not time—of admission. We used an enhanced longitudinal data set to estimate the ‘weekend effect’ over time and the effect of night-time admission on all-cause mortality rates.MethodsWe examined 246 350 emergency spells from a large teaching hospital in England between April 2004 and March 2014. Outcomes included 7-day, 30-day and in-hospital mortality rates. We conducted probit regressions to estimate the impact on the absolute difference in the risk of mortality of two key predictors: (1) admission on weekends (19:00 Friday to 06:59 Monday); and (2) night-time admission (19:00 to 06:59). Logistic regressions were used to estimate ORs for relative mortality risk differences.ResultsCrude 30-day mortality rate decreased from 6.6% in 2004/2005 to 5.2% in 2013/2014. Adjusted mortality risk was elevated for all out-of-hours periods. The highest risk was associated with admission on weekend night-times: 30-day mortality increased by 0.6 percentage points (adjusted OR: 1.17, 95% CI 1.10 to 1.25), 7-day mortality by 0.5 percentage points (adjusted OR: 1.23, 95% CI 1.12 to 1.34) and in-hospital mortality by 0.5 percentage points (adjusted OR: 1.14, 95% CI 1.08 to 1.21) compared with admission on weekday daytimes. Weekend night-time admission was associated with increased mortality risk in 9 out of 10 years, but this was only statistically significant (p<0.05) in 5 out of 10 years.ConclusionsThere is an increased risk of mortality for patients admitted as emergencies both on weekends and during the night-time. These effects are additive, so that the greatest risk of mortality occurs in patients admitted during the night on weekends. This increased risk appears to be consistent over time, but the effects are small and are not statistically significant in individual hospitals in every year.

scholarly journals 416 - Risk of Mortality Associated with Antipsychotics in Alzheimer's Disease

2020 ◽  
Vol 32 (S1) ◽  
pp. 132-132
Author(s):  
Liliana P. Ferreira ◽  
Núria Santos ◽  
Nuno Fernandes ◽  
Carla Ferreira
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Adverse Events ◽  
Mortality Risk ◽  
Antipsychotic Treatment ◽  
Serious Adverse Events ◽  
Risk Of Death ◽  
Mesh Terms ◽  
Risk Of Mortality ◽  
Increased Risk

Objectives: Alzheimer's disease (AD) is the most common cause of dementia and it is associated with increased mortality. The use of antipsychotics is common among the elderly, especially in those with dementia. Evidence suggests an increased risk of mortality associated with antipsychotic use. Despite the short-term benefit of antipsychotic treatment to reduce the behavioral and psychological symptoms of dementia, it increases the risk of mortality in patients with AD. Our aim is to discuss the findings from the literature about risk of mortality associated with the use of antipsychotics in AD.Methods: We searched Internet databases indexed at MEDLINE using following MeSH terms: "Antipsychotic Agents" AND "Alzheimer Disease" OR "Dementia" AND "Mortality" and selected articles published in the last 5 years.Results: Antipsychotics are widely used in the pharmacological treatment of agitation and aggression in elderly patients with AD, but their benefit is limited. Serious adverse events associated with antipsychotics include increased risk of death. The risk of mortality is associated with both typical and atypical antipsychotics. Antipsychotic polypharmacy is associated with a higher mortality risk than monotherapy and should be avoided. The mortality risk increases after the first few days of treatment, gradually reducing but continues to increase after two years of treatment. Haloperidol is associated with a higher mortality risk and quetiapine with a lower risk than risperidone.Conclusions: If the use of antipsychotics is considered necessary, the lowest effective dose should be chosen and the duration should be limited because the mortality risk remains high with long-term use. The risk / benefit should be considered when choosing the antipsychotic. Further studies on the efficacy and risk of adverse events with antipsychotics are needed for a better choice of treatment and adequate monitoring with risk reduction.

scholarly journals Procedural and remote outcome among patients undergoing urgent trans-catheter aortic valve implantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Berkovitch ◽  
A Segev ◽  
A Finkelstein ◽  
R Kornowski ◽  
H Danenberg ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hospital Mortality ◽  
Mortality Rates ◽  
P Value ◽  
Complication Rates ◽  
Increased Risk ◽  
Procedural Complication ◽  
Elective Procedure ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Severe aortic stenosis patients suffer frequent heart failure decompensations events often requiring hospitalization. In extreme situations patients can be found with pulmonary edema and cardiogenic shock, unresponsive to medical treatment. Urgent trans-catheter aortic valve implantation (TAVI) has emerged as a treatment option for these high-risk patients. Methods We investigated 3,599 patients undergoing TAVI. Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N=3,448) and those who had an urgent TAVI (N=151). Peri-procedural complications were documented according to the VARC-2 criteria. In hospital and 1-year mortality rates were prospectively documented. Results Mean age of the study population was 82±7, of whom 52% were female. Peri-procedural complication rates was significantly higher among patients with an urgent indication for TAVI compared to those having an elective procedure: valve malposition 3.6% vs. 0.6% (p-value=0.023), valve migration 3.2% vs. 0.9% (p-value=0.016), post procedure myocardial infarction 3.7% vs. 0.3% (p-value=0.004), and stage 3 acute kidney injury 2.6% vs. 0.5%, (p-value=0.02). Univariate analysis found that patients with urgent indication for TAVI had significantly higher in hospital mortality (5.8% vs. 1.4%, p-value&lt;0.001). similarly, multivariate analysis adjusted for age, gender and cardio-vascular risk factors found that patients with urgent indication had more than 5-folds increased risk of in-hospital mortality (OR 5.94, 95% CI 2.28–15.43, p-value&lt;0.001). Kaplan-Meier's survival analysis showed that patients undergoing urgent TAVI had higher 1-year mortality rates compared to patients undergoing an elective TAVI procedure (p-value log-rank&lt;0.001, Figure). Multivariate analysis found they had more than 2-folds increased risk of mortality at 1-year (HR 2.27, 95% CI 1.53–3.38, p&lt;0.001 compared to those having an elective procedure. Conclusions Patients with urgent indication for TAVI have higher in-hospital mortality and higher peri-procedural complication rates. However, if these patients survive the index hospitalization, they enjoy good prognosis. Kaplan-Meier's survival analysis Funding Acknowledgement Type of funding source: None

Long-term mortality rates and associated risk factors following primary and revision knee arthroplasty

2022 ◽  
Vol 104-B (1) ◽  
pp. 45-52
Author(s):  
Liam Zen Yapp ◽  
Nick D. Clement ◽  
Matthew Moran ◽  
Jon V. Clarke ◽  
A. Hamish R. W. Simpson ◽  
...  
Keyword(s):  
General Population ◽  
Knee Arthroplasty ◽  
Mortality Rates ◽  
Factors Associated ◽  
Revision Knee Arthroplasty ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Male Sex ◽  
Long Term Mortality

Aims The aim of this study was to determine the long-term mortality rate, and to identify factors associated with this, following primary and revision knee arthroplasty (KA). Methods Data from the Scottish Arthroplasty Project (1998 to 2019) were retrospectively analyzed. Patient mortality data were linked from the National Records of Scotland. Analyses were performed separately for the primary and revised KA cohorts. The standardized mortality ratio (SMR) with 95% confidence intervals (CIs) was calculated for the population at risk. Multivariable Cox proportional hazards were used to identify predictors and estimate relative mortality risks. Results At a median 7.4 years (interquartile range (IQR) 4.0 to 11.6) follow-up, 27.8% of primary (n = 27,474/98,778) and 31.3% of revision (n = 2,611/8,343) KA patients had died. Both primary and revision cohorts had lower mortality rates than the general population (SMR 0.74 (95% CI 0.73 to 0.74); p < 0.001; SMR 0.83 (95% CI 0.80 to 0.86); p < 0.001, respectively), which persisted for 12 and eighteight years after surgery, respectively. Factors associated with increased risk of mortality after primary KA included male sex (hazard ratio (HR) 1.40 (95% CI 1.36 to 1.45)), increasing socioeconomic deprivation (HR 1.43 (95% CI 1.36 to 1.50)), inflammatory polyarthropathy (HR 1.79 (95% CI 1.68 to 1.90)), greater number of comorbidities (HR 1.59 (95% CI 1.51 to 1.68)), and periprosthetic joint infection (PJI) requiring revision (HR 1.92 (95% CI 1.57 to 2.36)) when adjusting for age. Similarly, male sex (HR 1.36 (95% CI 1.24 to 1.49)), increasing socioeconomic deprivation (HR 1.31 (95% CI 1.12 to 1.52)), inflammatory polyarthropathy (HR 1.24 (95% CI 1.12 to 1.37)), greater number of comorbidities (HR 1.64 (95% CI 1.33 to 2.01)), and revision for PJI (HR 1.35 (95% 1.18 to 1.55)) were independently associated with an increased risk of mortality following revision KA when adjusting for age. Conclusion The SMR of patients undergoing primary and revision KA was lower than that of the general population and remained so for several years post-surgery. However, approximately one in four patients undergoing primary and one in three patients undergoing revision KA died within tenten years of surgery. Several patient and surgical factors, including PJI, were associated with the risk of mortality within ten years of primary and revision surgery. Cite this article: Bone Joint J 2022;104-B(1):45–52.

scholarly journals Mortality, causes of death and influence of medication use in patients with systemic lupus erythematosus vs matched controls

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 207-216
Author(s):  
Irene E M Bultink ◽  
Frank de Vries ◽  
Ronald F van Vollenhoven ◽  
Arief Lalmohamed
Keyword(s):  
Mortality Rate ◽  
Lupus Erythematosus ◽  
Mortality Rates ◽  
Cox Proportional Hazards ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Specific Mortality ◽  
Age And Sex

Abstract Objectives We wanted to estimate the magnitude of the risk from all-cause, cause-specific and sex-specific mortality in patients with SLE and relative risks compared with matched controls and to evaluate the influence of exposure to medication on risk of mortality in SLE. Methods We conducted a population-based cohort study using the Clinical Practice Research Datalink, Hospital Episode Statistics and national death certificates (from 1987 to 2012). Each SLE patient (n = 4343) was matched with up to six controls (n = 21 780) by age and sex. Cox proportional hazards models were used to estimate overall and cause-specific mortality rate ratios. Results Patients with SLE had a 1.8-fold increased mortality rate for all-cause mortality compared with age- and sex-matched subjects [adjusted hazard ratio (HR) = 1.80, 95% CI: 1.57, 2.08]. The HR was highest in patients aged 18–39 years (adjusted HR = 4.87, 95% CI: 1.93, 12.3). Mortality rates were not significantly different between male and female patients. Cumulative glucocorticoid use raised the mortality rate, whereas the HR was reduced by 45% with cumulative low-dose HCQ use. Patients with SLE had increased cause-specific mortality rates for cardiovascular disease, infections, non-infectious respiratory disease and for death attributable to accidents or suicide, whereas the mortality rate for cancer was reduced in comparison to controls. Conclusion British patients with SLE had a 1.8-fold increased mortality rate compared with the general population. Glucocorticoid use and being diagnosed at a younger age were associated with an increased risk of mortality. HCQ use significantly reduced the mortality rate, but this association was found only in the lowest cumulative dosage exposure group.

scholarly journals Unraveling the Association Between Gait and Mortality—One Step at a Time

2019 ◽  
Vol 75 (6) ◽  
pp. 1184-1190 ◽  
Author(s):  
Lisanne J Dommershuijsen ◽  
Berna M Isik ◽  
Sirwan K L Darweesh ◽  
Jos N van der Geest ◽  
M Kamran Ikram ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Gait Speed ◽  
Causes Of Death ◽  
Health Indicators ◽  
Cox Models ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Specific Mortality ◽  
One Step ◽  
Base Of Support

Abstract Background Slowness of walking is one of the very first signs of aging and is considered a marker for overall health that is strongly associated with mortality risk. In this study, we sought to disentangle the clinical drivers of the association between gait and mortality. Methods We included 4,490 participants of the Rotterdam Study who underwent a gait assessment between 2009 and 2015 and were followed-up for mortality until 2018. Gait was assessed with an electronic walkway and summarized into the domains Rhythm, Phases, Variability, Pace, Tandem, Turning, and Base of Support. Cox models adjusted for age, sex, and height were built and consecutively adjusted for six categories of health indicators (lifestyle, musculoskeletal, cardiovascular, pulmonary, metabolic, and neurological). Analyses were repeated in comorbidity-free individuals. Results Multiple gait domains were associated with an increased risk of mortality, including Pace (hazard ratio (HR) per SD worse gait, adjusted for other domains: 1.34 [1.19–1.50]), Rhythm (HR: 1.12 [1.02–1.23]) and Phases (HR: 1.12 [1.03–1.21]). Similarly, a 0.1 m/s decrease in gait speed was associated with a 1.21 (1.15–1.27) times higher hazard of mortality (HR fully adjusted: 1.14 [1.08–1.20]). In a comorbidity-free subsample, the HR per 0.1 m/s decrease in gait speed was 1.25 (1.09–1.44). Cause-specific mortality analyses revealed an association between gait speed and multiple causes of death. Conclusions Several gait domains were associated with mortality risk, including Pace which primarily represents gait speed. The association between gait speed and mortality persisted after an extensive adjustment for covariates, suggesting that gait is a marker for overall health.

A twin study of mortality after spousal bereavement

1998 ◽  
Vol 28 (3) ◽  
pp. 635-643 ◽  
Author(s):  
P. LICHTENSTEIN ◽  
M. GATZ ◽  
S. BERG
Keyword(s):  
Mortality Risk ◽  
Causal Effect ◽  
Spousal Bereavement ◽  
Risk Of Mortality ◽  
Related Risk ◽  
Increased Risk ◽  
Health Related ◽  
Married Individuals ◽  
And Control ◽  
Young Old

Background. Previous research has shown an increased risk of mortality after spousal bereavement, with the highest risk in the first weeks or months closest to the loss. One difficult issue in these designs is appropriate covariates and control groups.Method. This study is based on 1993 pairs of twins discordant for marital status and on 35860 married individuals from the Swedish Twin Registry born between 1886 and 1958 and followed for marital and vital status between 1981 and 1993.Results. Spousal bereavement was a risk factor for mortality for both men and women using the still married co-twin as a control to the widowed proband, and controlling for earlier health status and health-related risk factors. The mortality risk was higher for young-old (under 70 years) individuals, and for recently widowed than for longer-term widowed. Young-old women had a pattern with increased mortality risk during the first years after bereavement, but also a markedly decreased risk if they survived 4 years after bereavement, as compared to married women.Conclusions. The results support a causal effect of bereavement on mortality. The decrease in risk for long-term young-old women is congruent with reports by widows of psychological growth after bereavement, involving increased sense of mastery and competence after learning to live in new sets of circumstances following the loss of their husband.

scholarly journals Diarrhoea and preadmission antibiotic exposure in COVID-19: a retrospective cohort study of 1153 hospitalised patients

2021 ◽  
Vol 8 (1) ◽  
pp. e000593
Author(s):  
Bilal Akhter Mateen ◽  
Sandip Samanta ◽  
Sebastian Tullie ◽  
Sarah O’Neill ◽  
Zillah Cargill ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Antibiotic Exposure ◽  
Test Results ◽  
Risk Of Mortality ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Residual Confounding

ObjectiveThe aims of this study were to describe community antibiotic prescribing patterns in individuals hospitalised with COVID-19, and to determine the association between experiencing diarrhoea, stratified by preadmission exposure to antibiotics, and mortality risk in this cohort.Design/methodsRetrospective study of the index presentations of 1153 adult patients with COVID-19, admitted between 1 March 2020 and 29 June 2020 in a South London NHS Trust. Data on patients’ medical history (presence of diarrhoea, antibiotic use in the previous 14 days, comorbidities); demographics (age, ethnicity, and body mass index); and blood test results were extracted. Time to event modelling was used to determine the risk of mortality for patients with diarrhoea and/or exposure to antibiotics.Results19.2% of the cohort reported diarrhoea on presentation; these patients tended to be younger, and were less likely to have recent exposure to antibiotics (unadjusted OR 0.64, 95% CI 0.42 to 0.97). 19.1% of the cohort had a course of antibiotics in the 2 weeks preceding admission; this was associated with dementia (unadjusted OR 2.92, 95% CI 1.14 to 7.49). After adjusting for confounders, neither diarrhoea nor recent antibiotic exposure was associated with increased mortality risk. However, the absence of diarrhoea in the presence of recent antibiotic exposure was associated with a 30% increased risk of mortality.ConclusionCommunity antibiotic use in patients with COVID-19, prior to hospitalisation, is relatively common, and absence of diarrhoea in antibiotic-exposed patients may be associated with increased risk of mortality. However, it is unclear whether this represents a causal physiological relationship or residual confounding.

scholarly journals HSV-1 reactivation is associated with an increased risk of mortality and pneumonia in critically ill COVID-19 patients

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Antoine Meyer ◽  
Niccolò Buetti ◽  
Nadhira Houhou-Fidouh ◽  
Juliette Patrier ◽  
Moustafa Abdel-Nabey ◽  
...  
Keyword(s):  
Critically Ill ◽  
Mortality Risk ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Hospital Acquired Pneumonia ◽  
Simplex Virus ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
The Impact ◽  
Hsv 1

Abstract Background Data in the literature about HSV reactivation in COVID-19 patients are scarce, and the association between HSV-1 reactivation and mortality remains to be determined. Our objectives were to evaluate the impact of Herpes simplex virus (HSV) reactivation in patients with severe SARS-CoV-2 infections primarily on mortality, and secondarily on hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) and intensive care unit-bloodstream infection (ICU-BSI). Methods We conducted an observational study using prospectively collected data and HSV-1 blood and respiratory samples from all critically ill COVID-19 patients in a large reference center who underwent HSV tests. Using multivariable Cox and cause-specific (cs) models, we investigated the association between HSV reactivation and mortality or healthcare-associated infections. Results Of the 153 COVID-19 patients admitted for ≥ 48 h from Feb-2020 to Feb-2021, 40/153 (26.1%) patients had confirmed HSV-1 reactivation (19/61 (31.1%) with HSV-positive respiratory samples, and 36/146 (24.7%) with HSV-positive blood samples. Day-60 mortality was higher in patients with HSV-1 reactivation (57.5%) versus without (33.6%, p = 0.001). After adjustment for mortality risk factors, HSV-1 reactivation was associated with an increased mortality risk (hazard risk [HR] 2.05; 95% CI 1.16–3.62; p = 0.01). HAP/VAP occurred in 67/153 (43.8%) and ICU-BSI in 42/153 (27.5%) patients. In patients with HSV-1 reactivation, multivariable cause-specific models showed an increased risk of HAP/VAP (csHR 2.38, 95% CI 1.06–5.39, p = 0.037), but not of ICU-BSI. Conclusions HSV-1 reactivation in critically ill COVID-19 patients was associated with an increased risk of day-60 mortality and HAP/VAP.

scholarly journals Latent Class Trajectories of Biochemical Parameters and Their Relationship With Risk of Mortality Among Acute Organophosphorus Poisoning Patients

2021 ◽  
Author(s):  
Waqas Ahmed Farooqui ◽  
Mudassir Uddin ◽  
Rashid Qadeer ◽  
Kashif Shafique
Keyword(s):  
Hospital Mortality ◽  
Biochemical Parameters ◽  
Trajectory Analysis ◽  
Latent Profile Analysis ◽  
Latent Class ◽  
Elapse Time ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Organophosphorus Poisoning ◽  
Latent Profile

Abstract Objectives: To determine varying biochemical parameters and their relationship with mortality among organophosphorus poisoning patients through a latent class trajectory analysis.Methods: It was a retrospective cohort study. Patients with organophosphorus poisoning (OP) were admitted to the Intensive Care Unit (ICU) of Ruth Pfau Civil Hospital Karachi from August 2010 to September 2016. A total of 299 OP poisoning patients’ data along with demographic and biochemical parameters were retrieved from medical records. The key outcome measure was in-hospital mortality among acute poisoning patients accounting for gender, age, elapse time since poison ingestion, ICU stay, and biochemical parameters including random blood sugar, creatinine, urea, and electrolytes (sodium, chloride, potassium). The trajectories of parameters were formed using longitudinal latent profile analysis. These trajectories and repeated measures were used as independent variables to determine and compare the risk of mortality by Cox-Proportional-Hazards models. A p-value of <0.05 was considered statistically significant.Results: A total of 299 patients’ data were included with a mean age of 25.4±9.7 years and in-hospital mortality was 13.7%(n=41). In trajectory analysis, patients with high-declining and normal-increasing creatinine, high-remitting, and normal-increasing urea, high-remitting sodium, trajectories observed the highest mortality i.e. 67%(2/3), 75%(6/8), 67%(2/3), 75%(6/8), and 80% (4/5) respectively compared with other trajectories. On multivariable analysis, patients in high-declining creatinine class were sixteen times [HR:15.7,95%CI:3.4-71.6], normal-increasing was fifteen times [HR:15.2,95%CI:4.2-54.6] more likely to die compared with those who had normal consistent creatinine levels. Patients in extremely high-remitting urea trajectory were fifteen times [HR:15.4,95%CI:3.4-69.7], normal-increasing urea trajectory was four times [HR:3.9,95%CI:1.4-11.5] and in high-remitting sodium, the trajectory was six times [HR:5.6,95%C.I:2.0-15.8] more likely to die compared with those who were in normal-consistent trajectories of urea and sodium respectively.Conclusion: Using the latent profile approach, biochemical parameters (creatinine, urea, and sodium levels) were significantly associated with increased risk of mortality among OP poisoning patients.

scholarly journals Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index

2021 ◽  
Author(s):  
Maximilian Peter Forssten ◽  
Gary Alan Bass ◽  
Kai-Michael Scheufler ◽  
Ahmad Mohammad Ismail ◽  
Yang Cao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Severe Traumatic Brain Injury ◽  
Mortality Risk ◽  
Risk Index ◽  
Cardiac Risk ◽  
Increased Risk ◽  
Severe Tbi

Abstract Purpose Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients. Methods All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference. Results 259,399 patients met the study’s inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01–1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05–1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11–1.90), p = 0.006], compared to RCRI 0. Conclusion An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.

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