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

## TL;DR

This study identifies factors influencing traumatic brain injury deaths that occur outside hospitals in Australia.

## Contribution

The study provides new insights into determinants of out-of-hospital deaths following moderate to severe traumatic brain injury in Australia.

## Key findings

- 28.4% of traumatic brain injury deaths occurred outside an acute hospital setting.
- Younger adults and those with penetrating injuries were more likely to die outside any medical service area.
- South Australia had significantly lower odds of death outside medical services compared to other regions.

## Abstract

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

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.

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).

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.

Distribution of TBI cases by location of death