LAUSR

Purpose: To evaluate the incidence, determinants and impact on outcome of in‐hospital complications in adults with traumatic brain injury (TBI). Materials and methods: We conducted a multicenter cohort study of TBI patients admitted between 2007 and 2012 in an inclusive Canadian trauma system. Risk ratios of complications, odds ratios of mortality and geometric mean ratios of length of stay (LOS) were calculated using generalized linear models with adjustment for prognostic indicators and hospital cluster effects. Results: Of 12,887 patients, 3.2% had at least one neurological complication and 22.6% a non‐neurological complication. Mechanical ventilation, head injury severity, blood transfusion and neurosurgical intervention had the strongest correlation with neurological complications. Mechanical ventilation, the Glasgow Coma Scale, blood transfusion and concomitant injuries had the strongest correlation with non‐neurological complications. Neurological and non‐neurological complications were associated with a 85% and 53% increase in the odds of mortality, and a 60% and two‐fold increases in LOS, respectively. Conclusions: More than 20% of patients with TBI developed a complication. Many of these complications were associated with increased mortality and LOS. Results highlight the importance of prevention strategies adapted to treatment decisions and underline the need to improve knowledge on the underuse and overuse of clinical interventions. HIGHLIGHTS1/33 and 1/5 TBI admissions develop neurological and non‐neurological complications.50% increase in mortality and 100% increase in LOSTreatments explain more variation in complications rates than patient risk factors.Highlights the importance of prevention strategies adapted to treatment decisionsUnderlines the need to improve knowledge on intervention underuse and overuse