Causes of fatal traumatic brain injury in Finland

Abstract

OBJECTIVE The phenotype of patients who suffer fatal traumatic brain injury (TBI) is poorly characterized. The authors examined the external causes, contributing diseases, and preinjury medication in adult patients with fatal TBI in a nationwide Finnish cohort. METHODS Deaths caused by TBIs in Finland were examined among decedents aged ≥ 16 years during 2005–2020 from the national Cause of Death Registry. Usage of prescription medications prior to TBI was studied using medication purchase data from the Social Insurance Institution of Finland. RESULTS The cohort consisted of 71,488,347 person-years, 821,259 total deaths, and 14,630 TBI-related deaths during 2005–2020, of which 67% (n = 9792) occurred in men. Women were older than men among those who suffered TBI-related death (mean age 77.2 ± 17.1 vs 64.5 ± 19.5 years, p < 0.0001). The overall crude incidence rate of fatal TBIs was 20.5/100,000 person-years (28.1/100,000 in men and 13.2/100,000 in women). TBI was the cause of death in 1.8% of all deaths in the Finnish population during the study years, but in patients aged 16–19 years, TBIs caused more than 17% of all deaths. The most common external cause of fatal TBI was a fall (70%), followed by poisoning or toxic effects (20%) and violence or self-harm (15%) overall. In men, the order of the most common causes of fatal TBI was similar to overall results (64%, 25%, and 19%, respectively), while in women, the most common cause was a fall (82%), followed by complications in healthcare (10%) and poisoning or toxic effects (9%). Cardiovascular diseases, psychiatric diseases, and infections were the most common diseases contributing to death. Blood pressure (lowering) medications were the most common type of medications used before fatal TBI. CNS medications were the second most common medication group. In the context of fatal TBI in Europe, Finland remains at the upper end of fatal TBI incidence. CONCLUSIONS TBI is a common cause of death in young adults, whereas the incidence of fatal TBI becomes increasingly higher with age in Finland. Cardiovascular diseases and psychiatric conditions were the most common diseases related to death, with opposite age trends. Healthcare facility complications were an alarmingly common cause of death in women with fatal TBI.

Association of Central Nervous System–Affecting Medications With Occurrence and Short-Term Mortality of Traumatic Brain Injury

“…The frequency of opioid use varied considerably between age groups, with only 4% of patients with fatal TBI younger than 30 years using opioids and 18% of patients older than 90 years. 22 In this study, the strongest association with 30-day mortality was found for strong opioids, second-generation antipsychotics, and atypical antidepressants. There is no comprehensive explanation for why these drugs particularly are so strongly related to fatal TBI.…”

“…3 Other possible causes include violence, self-harm, and poisoning. 22 CNS-affecting drugs may predispose or play a role in all these causes. Notably, the interaction between medications and fall risk has been thoroughly studied, particularly in older adults.…”

“…25 In our previous study, we showed that 15% of fatal TBIs in Finland were caused by violence or self-harm, with intentional self-harm counting for 10% in total. 22 In addition, nearly 20% of all fatal TBIs were caused by poisoning, most of which occurred in young people. The main agents identified in any fatal suicide poisonings in Finland during 2005-2018 were antidepressants, opioids, and antipsychotics.…”

Adult-Onset Neuroepidemiology in Finland: Lessons to Learn and Work to Do

“…The incidence of traumatic brain injuries (TBI) is slightly above the western European average in Finland, but the TBI mortality is relatively high, suggesting that the injuries may be more severe than they are elsewhere [ 100 , 101 , 102 , 103 , 104 ]. The epilepsy incidence trends among elderly people may also have partially resulted from the increasing incidence of traumatic brain injury in this population [ 102 ], whereas age does not appear to be an independent risk factor for epilepsy after an haemorrhagic stroke in Finnish patients [ 105 , 106 ].…”